Tricuspid valve endocarditis associated to lupus erythematosus and thrombotic thrombocytopenic purpura

Infective endocarditis (IE) of native tricuspid valve represents only 5 to 10% of all cases of IE and rarely occur in absence of intravenous drug use, use of central venous catheters, cardiac pacemakers, congenital or acquired cardiac abnormalities, or without involvement of the immune status. It can be caused by various pathogens, most frequently by staphylococcus aureus. Prevalence of IE in Systemic Lupus Erythematosus (SLE) is around 1 to 4%. It is difficult to differentiate between IE associated with SLE and active SLE with Libman-Sacks vegetation. Thrombotic thrombocytopenic purpura associated with SLE is extremely rare. It has been established that it could be due to common pathogenetic factors represented by the decreased inhibition of ADAMTS-13 activity. Corticosteroids alter the natural history of cardiovascular manifestations of SLE; and although they represent a risk factor for IE in SLE, it has been reported that decreasing the incidence of Libman-Sacks vegetations exerts a beneficial effect by reducing the possibility of bacterial colonization.