Libman–Sacks vegetations detected by 3D echocardiography

A 35-year-old woman with a history of systemic lupus erythematosus presented with symptoms of congestive heart failure. She was treated with diuretics with resolution of her dyspnoea. Laboratory testing revealed a white-cell count of 7300/mm³, creatinine was 2.2 mg/dL, and C-reactive protein level was 10.2 mg/L (normal < 5). Repeated blood cultures were negative. Transthoracic echo demonstrated thickened mitral valve leaflets and severe mitral regurgitation. On 3D transoesophageal echocardiography, vegetations were observed on the atrial (Panel A, arrow) as well as the ventricular aspect (Panel B, arrows) of the posterior mitral leaflet, consistent with Libman–Sacks endocarditis (LSE).

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