Infective endocarditis causing acute aortic occlusion in a patient with systemic lupus erythematosus: A rare case report

Introduction: We present a unique case of acute aortic occlusion secondary to infective endocarditis (IE). Presentation of case: An Aboriginal Australian woman with systemic lupus erythematosus presented with fever, confusion, tachycardia, and tachypnoea and had cold, pulseless, insensate, and paralysed lower limbs. Computed tomography angiography revealed multifocal occlusion of the distal aorta and lower limb vessels. Broadspectrum antibiotic therapy was initiated alongside heparin infusion, and thrombectomy and four- compartment fasciotomy of the lower limbs were performed. IE, thrombotic thrombocytopenic purpura, and antiphospholipid syndrome were considered. IE was confirmed by the presence of methicillin-susceptible Staphylococcus aureus in blood cultures and new valvular echogenic lesions on echocardiography. Magnetic resonance imaging revealed diffused T9-T11 spinal cord infarcts. She received a prolonged course of intravenous antibiotics and intensive care and was hospitalised for 9 months. Thereafter, the patient was able to transfer and ambulate independently on flat surfaces and was discharged. Discussion: IE is associated with significant mortality and morbidity. It is commonly caused by S. aureus. Embolic events occur in 80 % of patients. Acute aortic occlusion secondary to IE has rarely been reported in the literature, and this is the first reported case involving the bilateral lower limbs. Conclusion: Patients may develop severe infections owing to immunosuppression. Septic emboli can occlude major arteries and cause acute limb ischaemia. A good understanding of the pathophysiology and aetiology of systemic thrombosis will lead to a thorough and broad consideration of differential diagnoses, especially for patients with complex comorbidities and a history of rheumatological disease and immunosuppression.