A 30-year-old woman presents with a heart murmur. There is a history of recurrent episodes of arthritis, skin rash, and glomerulonephritis. Blood cultures are negative. Laboratory tests for antinuclear antibodies (ANA) and anti-double-stranded DNA are positive. Which of the following is the most likely cause of heart murmur in this patient?
High-Yield Explanation
In patients with systemic lupus erythematosus, endocarditis is the most striking cardiac lesion, termed Libman-Sacks endocarditis. Nonbacterial vegetations are seen on the undersurface of the mitral valve close to the origin of the leaflets from the valve ring (Libman-Sacks endocarditis). There is fibrinoid necrosis of small vessels with focal degeneration of interstitial tissue. Rheumatic fever (choice E) is not commonly associated with ANAs seen in this case.Diagnosis: Systemic lupus erythematosis