A 47-year-old woman with long-standing systemic lupus erythematosus has sterile verrucous vegetations on both sides of the mitral leaflets. Histology shows bland platelet-fibrin deposits without inflammation or bacteria. What is this lesion called, and which valve complication may it later produce?

• A Libman-Sacks endocarditis, which can heal with fibrous thickening causing valvular stenosis or regurgitation ✓
• B Non-bacterial thrombotic endocarditis, which always embolises to the brain within weeks
• C Rheumatic verrucae, which progress inevitably to commissural fusion
• D Marantic endocarditis, which requires lifelong anticoagulation in every patient

Explanation

Libman-Sacks (verrucous) endocarditis is the characteristic cardiac lesion of SLE and antiphospholipid syndrome: small sterile warty vegetations on either side of the leaflet, histologically bland fibrin-platelet deposits without neutrophils or organisms. Healing leaves fibrous thickening that can produce mild stenosis or regurgitation. Marantic (non-bacterial thrombotic) endocarditis is associated with wasting states and adenocarcinomas, not lupus, and its management depends on embolic risk rather than universal anticoagulation.

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.