An unusual case of non‐infective endocarditis in undiagnosed antiphospholipid syndrome

Jessica V Yao, Subodh B Joshi, John G Morgan and Melissa GY Lee
Med J Aust 2021; 215 (7): . || doi: 10.5694/mja2.51246
Published online: 4 October 2021

A 57‐year‐old man presented with left facial droop and dysarthria due to a multiterritory ischaemic stroke affecting the right posterior and middle cerebral arteries. His previous history included a segmental pulmonary embolus in the setting of pneumonia. He was not taking any regular medications and denied recreational drug use. There was no relevant family history. He was haemodynamically stable, afebrile and euvolaemic. White cell count was normal at 7.8 × 109/L (reference interval [RI], 4–12 × 109/L). C‐reactive protein was mildly elevated at 9 mg/L (RI, < 5 mg/L). On day 1, transthoracic echocardiogram revealed a vegetation on the anterior mitral valve leaflet tip with moderate to severe mitral regurgitation, normal left atrial size and biventricular size and systolic function. Three sets of blood cultures were taken before commencing intravenous ceftriaxone and flucloxacillin. He was transferred to our hospital for surgical consideration.

  • 1 Royal Melbourne Hospital, Melbourne, VIC
  • 2 University of Melbourne, Melbourne, VIC


Competing interests:

No relevant disclosures.

  • 1. Lee V, Gilbert JD, Byard RW. Marantic endocarditis — a not so benign entity. J Forensic Leg Med 2012; 19: 312–315.
  • 2. Bussani R, De‐Giorgio F, Pesel G, et al. Overview and comparison of infectious endocarditis and non‐infectious endocarditis. a review of 814 autoptic cases. In Vivo 2019; 33: 1565–1572.
  • 3. Liu J, Frishman WH. Nonbacterial thrombotic endocarditis: pathogenesis, diagnosis, and management. Cardiol Rev 2016; 24: 244–247.
  • 4. Joshi SB, Richards MJ, Holt DQ, et al. Marantic endocarditis presenting as recurrent arterial embolization. Int J Cardiol 2009; 132: e14–16.
  • 5. Lenz CJ, Mankad R, Klarich K, et al. Antiphospholipid syndrome and the relationship between laboratory assay positivity and prevalence of non‐bacterial thrombotic endocarditis: a retrospective cohort study. J Thromb Haemost 2020; 18: 1408–1414.


remove_circle_outline Delete Author
add_circle_outline Add Author

Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Online responses are no longer available. Please refer to our instructions for authors page for more information.