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Libman-Sacks Endocarditis — EECC MCQ

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ModerateValvular Heart DiseaseLibman-Sacks EndocarditisEECC

A 55-year-old woman with lupus (SLE) on immunosuppression presents with breathlessness. Echocardiography shows thickening of the mitral valve leaflets with small verrucous vegetations on the atrial surface of the mitral valve. Blood cultures are sterile. What is the most likely diagnosis?

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Correct answer: A — Libman-Sacks endocarditis

Libman-Sacks endocarditis is a sterile (non-infective) valvulitis associated with SLE and antiphospholipid syndrome. Characteristic features include small (typically <10 mm), verrucous vegetations on the atrial surface of the mitral valve (or ventricular surface of the aortic valve). It can cause valvular regurgitation or rarely stenosis. Unlike infective endocarditis, Libman-Sacks vegetations are sterile, and patients are often afebrile. However, they can embolise and serve as a nidus for superimposed infective endocarditis. Treatment involves managing the underlying SLE and anticoagulation if antiphospholipid antibodies are present. Surgery is occasionally required for severe valvular dysfunction.

Reference: ESC (2023): Guidelines on Infective Endocarditis; ESC Textbook of Cardiovascular Medicine