A 35-year-old woman with systemic lupus erythematosus presents with an embolic stroke. Echocardiography shows small, sterile vegetations on both the atrial and ventricular sides of the mitral valve. Blood cultures are repeatedly negative. What is the most likely diagnosis?

• A Libman-Sacks endocarditis ✓
• B Nonbacterial thrombotic endocarditis (NBTE)
• C Infective endocarditis
• D Antiphospholipid syndrome with valve thrombosis

Explanation

Libman-Sacks endocarditis is associated with SLE and antiphospholipid syndrome. The vegetations are small, sterile, and characteristically found on both sides of the valve (atrial and ventricular surfaces). NBTE (marantic endocarditis) typically affects the ventricular side only and is associated with malignancy, not SLE. Negative blood cultures exclude infective endocarditis.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.