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Case Reports in Rheumatology
Volume 2015 (2015), Article ID 373201, 5 pages
Case Report

Embolic Stroke as the Initial Manifestation of Systemic Lupus Erythematosus

1Department of Internal Medicine, Division of Rheumatology, Henry Ford Hospital, Wayne State University, Detroit, MI 48202, USA
2Department of Internal Medicine, Division of Rheumatology, University of Michigan, Ann Arbor, MI 48109, USA
3Department of Internal Medicine, Division of Cardiology, Henry Ford Hospital, Detroit, MI 48202, USA

Received 26 May 2015; Accepted 9 July 2015

Academic Editor: Masataka Kuwana

Copyright © 2015 Reshma M. Khan et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


We present a case of a 21-year-old African-American female with no significant medical history, who presented to the emergency department with a one-week history of blurry and double vision. Ophthalmology evaluation revealed bilateral retinal artery occlusion. Further workup with imaging of the brain was consistent with an ischemic stroke. Hereditary hypercoagulable workup was unremarkable and initial testing for antiphospholipid syndrome was positive. She underwent transesophageal echocardiogram (TEE), which showed severe mitral regurgitation and thickening of mitral valve leaflets consistent with Libman-Sacks endocarditis. Autoimmune workup was positive for IF-ANA, anti-RNP, and anti-Smith antibody. She fulfilled 4/11 of the ACR criteria and met 5 of the SLICC (Systemic Lupus International Collaborating Clinics) criteria for lupus (nonscaring alopecia, thrombocytopenia, positive ANA, and positive anti-Smith and positive anti-phospholipid antibodies). This case highlights the importance of early recognition of underlying connective tissue diseases and timely management of these diseases in young patients with no previous manifestations of diseases.