# A young lady presenting with acute limb ischemia secondary to systemic lupus erythematosus, antiphospholipid syndrome and infective endocarditis

## TL;DR

A 35-year-old woman with no prior history developed acute limb ischemia due to a rare combination of lupus, antiphospholipid syndrome, and heart infection.

## Contribution

This case highlights the rare initial presentation of acute limb ischemia due to SLE, APLS, and infective endocarditis.

## Key findings

- Acute limb ischemia was caused by a combination of SLE, APLS, and infective endocarditis.
- The patient responded well to treatment with antibiotics, steroids, and anticoagulants.
- Comprehensive evaluation is crucial for diagnosing complex cases of acute limb ischemia.

## Abstract

We report a case of a 35 years old lady presenting with acute upper limb ischemia secondary to systemic lupus erythematosus (SLE), antiphospholipid syndrome (APLS) and infective endocarditis (IE). It is rare for SLE/APLS to present with acute limb ischemia (ALI) as the initial manifestation. The patient presented with high grade fever along with pain and numbness in her right upper limb. On examination her right upper limb was cold to touch and the peripheral pulses were not palpable. There was also an audible pansystolic murmur in the mitral area. CT Angiography confirmed a complete occlusion of the right axillary artery while echocardiogram revealed severe mitral regurgitation with large vegetations on the mitral valve leaflets, suggesting infective endocarditis.

After the patient’s clinical deterioration and considering the severity of the ischemic condition, additional investigations were conducted, which ultimately led to the diagnosis of SLE with APLS. Management included antibiotic therapy for IE and high dose of IV steroids and anticoagulants for SLE/APLS, to which she responded well. This case emphasizes the significance of conducting a comprehensive evaluation of all possible causes of acute limb ischemia, while considering the patient’s medical history and physical examination findings.