LAUSR

Background The infection of a native or prosthetic heart valve usually occurs in patients with structural valvular anomalies that predispose to turbulent flows. Manifestations such as arthralgia, arthritis or back pain appear in up to 40% of patients, which acts as a confounding factor when this infection occurs in patients with rheumatic diseases. On the other hand, in the latter patients, noninfectious endocarditis has been described, which adds even more complexity to the diagnosis. Objectives To describe the characteristics of endocardial lesions in patients with rheumatic diseases. Methods Patients attending clinics at the Department of Rheumatology were analyzed to determine how many of them required hospitalization for causes directly related to endocardial lesion, from January 2015 until December 2018. The following information was recorded: age, sex, type of rheumatic disease, duration of the disease, immunosuppressive treatment, characteristics of endocardial lesions, complications of endocardial lesions, and cardiovascular risk factors. Results All patients were identified from an electronic database. Results regarding to demographic and clinical data are as follows: Age Sex Rheumatic disease Baseline Treatment Endocardial lesions clinical debut Blood culture Endocardial lesions Complications Clinical evolution 1° case 27 Male Dermatomyositis Methotrexate + glucocorticoids Digital ulcers + Febrile syndrome Staph. Aureus Infectious endocarditis Mitral valve perforation Resolution after cardiac surgery 2° case 64 Male Rachialgia NSAIDS Febrile syndrome Strept. Gallolyticus Infectious endocarditis - - 3° case 53 Female Systemic Sclerosis Tocilizumab + glucocorticoids Febrile syndrome - Nonbacterial thrombotic endocarditis Acute ischaemia right lower limb Resolution after embolectomy 4° case 13 Female Autoinmune hemolytic anemia Glucocorticoids,splenectomy Ischaemic stroke - Auricular myxoma - Systemic lupus ANA and anti-DNA + 5° case 48 Female Autoinmune thrombocytopenia Glucocorticoids Iliac artery embolism - Auricular myxoma - Immunologic síndrome secondary to myxoma Conclusion The spectrum of endocardial involvement in patients with rheumatic diseases is variable. In this case review, we found lesions of different origin: infectious, thrombotic and tumoral. The appearance of fever of unknown origin in patients with rheumatic diseases, requires ruling out an endocarditis, needing transesophageal echocardiography in case the transthoracic study, which is less sensitive, is negative. It is striking the case of patient 3, a systemic sclerosis with calcinosis in limbs, whose endocardial wart, was studied histologically, revealing in its composition mainly calcium and fibrin. We have not found a bibliographic reference of calcium endocarditis in systemic sclerosis. In conclusion, patients with rheumatic diseases can develop infectious endocarditis, but also thrombotic valvular vegetations, as well as myxomas whose consequences, from their clinical debut, may pose life-threatening situations for the patient. The presence of fever, stroke or embolic events in these patients should put us on the track of an underlying endocardial involvement. References [1] Am J Med (2007) 120, e1-e2 [2] World J Cardiol 2014 September 26; 6(9): 993-1005 [3] Rev Esp Enferm Metab óseas 2002;11(2): 50-58 Disclosure of Interests Sergio Rodríguez Montero: None declared, Consuelo Ramos Giráldez Speakers bureau: Sanofi, NAHIA PLAZA: None declared, Jose Luis Marenco Speakers bureau: abbie, pfizer, novartis, janmsen