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International Journal of Rheumatology
Volume 2010 (2010), Article ID 932157, 4 pages
http://dx.doi.org/10.1155/2010/932157
Case Report

Is It Antiphospholipid Syndrome?

1Rheumatology Unit, L. Sacco University Hospital, Via G.B. Grassi 74, 20157 Milano, Italy
2Internal Medicine Unit, L. Sacco University Hospital, Via G.B. Grassi 74, 20157 Milano, Italy

Received 11 October 2010; Accepted 7 December 2010

Academic Editor: Ronald F. van Vollenhoven

Copyright © 2010 Maria Chiara Ditto 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.

Abstract

The diagnosis of bacterial endocarditis remains a challenge, as nearly half of cases develop in the absence of preexistent heart disease and known risk factors. Not infrequently, a blunted clinical course at onset can lead to erroneous diagnoses. We present the case of a 47-year-old previously healthy man in which a presumptive diagnosis of antiphospholipid syndrome was made based on the absence of echocardiographically detected heart involvement, a negative blood culture, normal C-reactive protein (CRP) levels, a positive lupus anticoagulant (LAC) test, and evidence of splenic infarcts. The patient eventually developed massive aortic endocarditic involvement, with blood cultures positive for Streptococcus bovis, and was referred for valvular replacement. This case not only reminds us of the diagnostic challenges of bacterial endocarditis, but also underlines the need for a critical application of antiphospholipid syndrome diagnostic criteria.