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Antiphospholipid syndrome masquerading as a case of infective endocarditis
  1. Sarah Micallef1,
  2. Charles Mallia Azzopardi2
  1. 1Department of Medicine, Mater Dei Hospital, Msida, Malta
  2. 2Infectious Diseases, Mater Dei Hospital, Msida, Malta
  1. Correspondence to Dr Sarah Micallef, sarah.a.micallef{at}


A 54-year-old Caucasian woman presented with an episode of loss of consciousness and dysphasia. MRI revealed a number of ischaemic foci indicating an embolic source. Echocardiography showed a mitral valve vegetation. After taking three sets of blood cultures, she was started on empirical treatment for infective endocarditis. The blood cultures remained negative and a presumed diagnosis of culture-negative endocarditis was entertained. However, despite the antibiotic therapy, the patient deteriorated further. Subsequently the patient was found to be positive for antiphospholipid antibodies. Eventually, after a convoluted hospital stay, a diagnosis of antiphospholipid syndrome complicated by Libman-Sacks endocarditis was reached. The patient was treated with steroids and anticoagulation with dramatic improvement.

  • immunology
  • stroke
  • vasculitis
  • connective tissue disease
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  • Contributors SM was involved with the case data collection, the case write-up and literature review in preparation for the discussion. CMA was the caring consultant of the patient and critically reviewed the case report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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