An unusual case of pacemaker endocarditis in a patient with antiphospholipid syndrome

We report the case of a 50-year-old woman with systemic lupus erythematosus who had previously undergone pacemaker implantation. She developed recurrent pulmonary thromboembolism and was diagnosed with antiphospholipid syndrome. During investigation, pacemaker endocarditis was discovered, and the system was surgically explanted. Surprisingly, all microbiological studies, including culture of the extracted material and extensive serological analysis, were negative and she remained well with anticoagulation plus her usual immunosuppressant regimen.The data indicate that her pacemaker endocarditis could be an equivalent of the nonbacterial thrombotic endocarditis often described in native valves.

ResumoDescreve-se o caso de uma doente de 50 anos com lúpus eritematoso sistémico e história prévia de implantação de pacemaker. Esta desenvolveu tromboembolismo pulmonar recorrente, tendo-lhe sido diagnosticada síndrome antifosfolipídica. Durante a investigação foi descoberta uma endocardite de pacemaker, tendo sido sujeita a extracção cirúrgica do sistema. Inesperadamente, todos os exames microbiológicos, incluindo culturas do material removido, e extensa análise serológica, foram negativos, tendo a doente se mantido clinicamente estável com anticoagulação oral e o habitual regime imunossupressor.Os dados indicam que a esta endocardite de pacemaker poderá ser um equivalente da endocardite trombótica não bacteriana, habitualmente descrita em válvulas nativas.