A Rare Case of Mistaken Identity: Mitral Valve Prolapse Disguised as Endocarditis in Systemic Sclerosis

Abstract

Systemic sclerosis (SSc) is a systemic disease involving collagen overproduction, microvascular damage, and immune activation.Organ involvement appears early, including Raynaud's phenomenon, lung fibrosis, renal crisis, and cardiac complications. Cardiac issues occur in 20–80% of patients, depending on the study. Mitral valve prolapse is seen in up to 60% of cases but is often asymptomatic and hemodynamically insignificant. Due to its rarity, valvular involvement is not a typical feature of SSc, making this case particularly noteworthy. We report the case of a 61-year-old diabetic patient hospitalized for MRSA septicemia, complicated by meningitis and a corneal abscess. She was transferred to cardiology after transthoracic echocardiography suggested mitral valve vegetation. On admission, she was asymptomatic with right upper limb paresis and mucocutaneous signs suggestive of scleroderma. Echocardiography revealed a calcified mitral valve with suspected vegetation and transesophageal echocardiography showed P3 prolapse without mobile vegetations Immunological tests confirmed systemic sclerosis,The patient was transferred to internal medicine for specialized management of systemic sclerosis. Cardiac involvement in systemic sclerosis (SSc) is often silent and may be detected early through imaging modalities like echocardiography, ECG, CT, and MRI. Mitral valve prolapse occurs in about 20% of SSc-related valvular diseases, with unclear pathophysiology likely linked to inflammation and microvascular damage. Valvular involvement in SSc may resemble that in non-SSc patients, making diagnosis challenging. Echocardiography remains key for assessing valve structure, while cardiac CT and MRI offer complementary insights. In our case, mitral prolapse was confirmed only via transesophageal echocardiography, while initial suspicion of endocarditis was misleading due to infectious context and TTE findings.