Libman-Sacks endocarditis is characterized by sterile vegetations. Which of the following accurately describes its pathological features compared to infective endocarditis?

• A Small, flat, sterile, fibrin-platelet vegetations along the valve closure line on BOTH surfaces of the mitral and tricuspid valves, associated with antiphospholipid syndrome and SLE ✓
• B Large, irregular, friable vegetations on the ventricular surface of mitral valve with neutrophilic infiltrate
• C Row of small vegetations along the atrial surface of valve leaflet margins without inflammation, associated with rheumatic fever
• D Bulky polypoid vegetations at valve destruction sites with underlying abscess, caused by Staphylococcus aureus

Explanation

Libman-Sacks endocarditis (nonbacterial thrombotic endocarditis of SLE/antiphospholipid syndrome) produces small, flat, irregular, sterile vegetations composed of fibrin and immune complexes that characteristically occur on BOTH surfaces of the mitral (and occasionally tricuspid) valve, not restricted to the closure line. This distinguishes it from: acute rheumatic fever (row of small vegetations along the closure line on the atrial surface only, due to valvulitis), infective endocarditis (large, irregular, destructive vegetations with bacteria and neutrophils), and marantic/nonbacterial thrombotic endocarditis of debilitating illness (small, sterile vegetations at the line of closure, predominantly mitral/aortic, in cachectic patients).

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.