The Valvular Involvement of Lupus: Congestive Heart Failure Can Be The Presenting Feature of Systemic Lupus Erythematosus

Valvular heart disease is the most important cardiac manifestation of systemic lupus erythematosus (SLE). However, severe mitral valve regurgitation necessitating valvular surgery due to SLE is rare. We report a 22-year-old male patient presenting with symptoms of congestive heart failure initially in whom lupus and severe mitral valve regurgitation were diagnosed. In our patient, four of the American College of Rheumatology diagnostic criteria for SLE were present, including serositis, hematological abnormalities, positive ANA (640X), and positive double-stranded DNA (640X). This patient eventually underwent mitral valve surgery with good clinical results. Pathological examination of the excised mitral valve leaflet showed degenerated valve with chronic inflammatory cell infiltration which was consistent with Libman-Sacks endocarditis. It serves as a reminder that SLE (even in a male patient) may be an underlying cause for the development of severe mitral valve regurgitation.