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Libman-Sacks Endocarditis — SCE Rheumatology MCQ

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ModerateSLE & Antiphospholipid SyndromeLibman-Sacks EndocarditisSCE Rheumatology

A 35-year-old woman with systemic lupus erythematosus and persistently positive antiphospholipid antibodies is found to have small irregular mitral-valve vegetations on transoesophageal echocardiography. She is afebrile, and repeated blood cultures are negative, with no other clinical evidence of infection. Which pathological description best characterises these lesions?

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Correct answer: E — Sterile verrucous fibrin-platelet vegetations associated with immune-mediated valvular injury

Libman-Sacks endocarditis consists of sterile verrucous vegetations formed principally from fibrin and platelets on valves affected by immune-mediated injury. It is associated with SLE and antiphospholipid antibodies, most often affects the mitral or aortic valve, and may cause regurgitation or systemic embolisation. Lambl excrescences are thin, usually incidental strands at valve closure lines. Carcinoid heart disease causes plaque-like fibrosis, predominantly of right-sided valves. Infective endocarditis contains microorganisms with inflammatory and destructive changes; negative cultures alone do not exclude infection, but the overall clinical context here supports a non-infective lesion. Rheumatic valve disease instead produces commissural fusion, leaflet thickening and chordal shortening.

Reference: Lee JL, Naguwa SM, Cheema GS, Gershwin ME. Revisiting Libman-Sacks endocarditis: a historical review and update. Clinical Reviews in Allergy & Immunology. 2009;36:126-130. https://pubmed.ncbi.nlm.nih.gov/8803890/