Gonococcal endocarditis in a patient with systemic lupus erythematosus

There is mounting evidence that patients with systemic lupus erythematosus(SLE) are prone to disseminated neisserial infections. We describe thefirst proven case of gonococcal endocarditis affecting the pulmonary valvein a patient known to have SLE. The clinical clues and pitfalls indiagnosis are discussed, and the role of echocardiography is highlighted.Possible reasons for the association of gonococcal endocarditis with SLEinclude pre-existing Libman. Sacks endocarditis, complement deficiency andabnormalities of the reticuloendothelial system.