A 60-year-old patient with rheumatic heart disease presents with acute stroke. Echocardiography shows mitral stenosis. Valvular vegetations at autopsy are small (1-2 mm), firm, and located on the line of closure of both mitral and tricuspid valve leaflets on the atrial surface. These findings characterize:

• A Infective (bacterial) endocarditis
• B Rheumatic (verrucous) endocarditis ✓
• C Libman-Sacks endocarditis
• D Nonbacterial thrombotic (marantic) endocarditis

Explanation

Rheumatic endocarditis produces small (1-2 mm), warty, sterile vegetations called McCallum plaques along the line of closure of valve leaflets, most prominently on the atrial surface of the mitral valve. This results from immunologically mediated valve damage in acute rheumatic fever, where molecular mimicry between streptococcal M protein and cardiac myosin leads to cross-reactive antibody and T cell injury. Libman-Sacks vegetations in SLE are larger, irregular, and may involve both surfaces of the leaflet.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.