Libman-Sacks endocarditis is the non-infective endocarditis associated with SLE. Which distinguishing feature separates it from acute rheumatic fever (RF) endocarditis regarding the location of vegetations?

• A Libman-Sacks affects only right-sided valves; RF affects mitral valve only
• B Libman-Sacks shows vegetations on BOTH surfaces of valve leaflets; RF shows vegetations only on the atrial surface along the line of closure ✓
• C Libman-Sacks shows large, destructive vegetations; RF shows small, non-destructive ones
• D Libman-Sacks is associated with mitral stenosis; RF causes mitral regurgitation

Explanation

Libman-Sacks endocarditis (in SLE) produces small, irregular, sterile vegetations on BOTH the atrial AND ventricular surfaces of valve leaflets (due to immune complex deposition throughout the valve). In acute rheumatic fever, small (1-3 mm), firm, wart-like vegetations form along the line of closure on the atrial surface (from endocarditis triggered by molecular mimicry — anti-streptococcal antibodies cross-react with valve glycoproteins). In infective endocarditis, large, bulky, destructive vegetations are characteristic. RF causes mitral regurgitation acutely; chronic scarring leads to mitral stenosis.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.