A 26-year-old woman with systemic lupus erythematosus is evaluated for a new murmur. Echocardiography shows small, firm vegetations on the ventricular surface of the mitral leaflets, with diffuse leaflet thickening and mild regurgitation. She has a history of recurrent miscarriage and positive lupus anticoagulant. What is the most likely diagnosis?

• A Marantic endocarditis secondary to occult malignancy
• B Libman-Sacks endocarditis associated with antiphospholipid antibodies ✓
• C Chronic rheumatic mitral valve disease
• D Infective endocarditis with blood culture-negative HACEK infection

Explanation

Libman-Sacks (verrucous) endocarditis is the characteristic cardiac lesion of SLE and antiphospholipid syndrome. Sterile vegetations form on either or both surfaces of the leaflets, most often mitral, and are strongly linked to antiphospholipid antibodies, which this patient's obstetric history supports. Rheumatic disease produces commissural fusion and leaflet scarring rather than bilateral surface vegetations, and marantic vegetations occur on lines of closure in cachectic cancer patients.

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.