A 30-year-old woman with systemic lupus erythematosus dies of renal failure. At autopsy, the mitral valve shows sterile, friable vegetations measuring up to 4 mm deposited on both the atrial and ventricular surfaces of the leaflets, with underlying leaflet fibrosis. Histologically the vegetations contain platelets and fibrin with neutrophils. This finding is:

• A Healed infective endocarditis
• B Non-bacterial thrombotic endocarditis of marantic type
• C Acute rheumatic valvulitis with Aschoff bodies
• D Libman-Sacks endocarditis associated with antiphospholipid antibodies ✓

Explanation

Libman-Sacks (verrucous) endocarditis of SLE produces small sterile vegetations on both sides of the leaflets, a distribution unique to this entity, and is strongly associated with antiphospholipid antibodies. Marantic endocarditis occurs in wasting states and cancers, with larger vegetations confined to the line of closure. Rheumatic valvulitis shows Aschoff bodies and affects mainly the mitral leaflet surface facing atrial flow, and healed infective endocarditis leaves perforation or scarring rather than bilateral verrucae.

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.