Case Report of Lupus Patient with Unusual Embolic Stroke Symptoms

A new study led by researchers at the Henry Ford Hospital in Detroit reported a case of systemic lupus erythematosus (SLE) linked to stroke-like symptoms. The study is entitled “Embolic Stroke as the Initial Manifestation of Systemic Lupus Erythematosus” and was published in the journal Case Reports in Rheumatology.

SLE is a severe autoimmune disease in which the body’s own immune system overreacts and attacks healthy joints and organs through autoantibodies, resulting in inflammation, swelling, pain, disability and often in tissue destruction in multiple organs including the skin, musculoskeletal system, kidneys and central nervous system.

In this study, researchers present the case of a 21-year-old African-American woman who was admitted to the Henry Ford Hospital with one-week complaints of pain, redness, blurry and double vision in the right eye. The patient also reported having experienced agonizing headaches linked to her eye symptoms, unintentional weight gain, constipation, fever, fatigue and shortness of breath with exertion. She had high blood pressure and heart murmur. Importantly, there was the report of SLE in her family.

An ophthalmology examination revealed bilateral retinal artery occlusion, which means that the retinal vascular lumen was obstructed by an embolus, blood clot or as a consequence of damage to a vessel wall. Imaging of the patient’s brain suggested that the woman had suffered an ischemic stroke, the result of the obstruction of a blood vessel supplying the brain. A transesophageal echocardiogram (TEE) showed that the patient also had severe mitral regurgitation and thickening of mitral valve leaflets that indicated a Libman-Sacks endocarditis, a disorder characterized by inflammation of the endocardium (the inner layer of the heart). Skin examination revealed a diffuse macular hyper pigmentation of her back. The patient was found to have elevated levels of inflammatory biomarkers and positive results for lupus anticoagulant and lupus serology.

Based on the clinical presentation, evaluation and test results, the woman was diagnosed with Libman-Sacks endocarditis linked to SLE. The patient was treated with the anticoagulants heparin and warfarin, and daily prednisone for her lupus symptoms. Despite having been submitted to repeated laser photocoagulation treatment, the patient’s vision failed to improve significantly. The patient was discharged under aspirin, warfarin and prednisone treatment, and was eventually submitted to mitral valve repair.

The research team emphasizes that this case report of an SLE patient with Libman-Sacks endocarditis shows the importance of an early diagnosis of lupus cases that have an unusual initial clinical presentation and the timely management of the disease in young patients.