Libman-Sacks endocarditis of the mitral valve as a first presentation of systemic lupus erythematosus.

Libman-Sacks endocarditis (LSE) is noninfectious verrucous vegetation lesion that can mimic infective endocarditis and the mitral valve is commonly involved. Although the exact pathogenesis remains unclear, the presence of LSE is associated with primary antiphospholipid syndrome (APS) and APS secondary to systemic lupus erythematosus (SLE). The presentation varies from mild symptoms to fulminant disease with high thromboembolic risk. Here, we present a case of LSE in female patient presented with shortness of breath and recurrent strokes but no clinical features of SLE. High index of suspicion remains a key factor in making the correct diagnosis.