Treatment of a pregnant patient with cardiogenic shock due to bacterial endocarditis combined with Libman-Sacks endocarditis: a case report and literature review

Abstract Background: As one of the most common cardiac manifestations of systemic lupus erythematous (SLE), Libman-Sacks (LS) endocarditis is a nonbacterial form of thrombotic endocarditis characterized by sterile vegetations deposited on heart valves consisting of fibrin mixed with immune complexes and platelets. Although patients with LS endocarditis usually have no significant valvular disease, persistent LS endocarditis may be complicated by bacterial endocarditis, leading to serious complications, including acute valve regurgitation, acute heart failure, and even cardiogenic shock, which are rare in pregnant patients. Therefore, such patients with atypical SLE manifestations combined with various complications deserve more attention. Case presentation: We reported a rare case of a pregnant patient without an SLE history who progressed to cardiogenic shock resulting in a preterm birth. After the delivery of the fetus, it was considered that the patient had bacterial endocarditis according to the results of lab tests and echocardiography. LS endocarditis was also found after surgery. Moreover, SLE with catastrophic antiphospholipid syndrome (CAPS) was also confirmed during the course of treatment. Finally, the combined use of methylprednisolone and human immunoglobulin injection was carried out, the patient’s condition improved, and she was discharged on the 13th postoperative day. Conclusion: The interference of infective endocarditis with the type of preexisting lesion in the disease process can influence our judgment and treatment decisions, which is worth noting.