Libman-Sacks endocarditis in SLE characteristically produces vegetations on:

• A The leading edge of valve leaflets, affecting the aortic valve most commonly
• B The ventricular surface of the mitral leaflet only, with large destructive vegetations
• C Both surfaces (atrial and ventricular) of mitral and tricuspid leaflets, without destroying the valve ✓
• D The mural endocardium of the left atrial wall near the pulmonary veins

Explanation

Libman-Sacks endocarditis (non-bacterial thrombotic endocarditis in SLE) produces small, sterile, warty vegetations on both the atrial (upstream) and ventricular (downstream) surfaces of the atrioventricular valves, most commonly the mitral and tricuspid valves. This bilateral surface involvement distinguishes it from infective endocarditis (vegetations on the upstream/low-pressure surface) and rheumatic endocarditis (vegetations on the line of closure of valve leaflets). The vegetations are composed of platelet-fibrin material with immune complexes and are not destructive.

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

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Written and medically reviewed by the StethoPrep medical team.