Libman-Sacks Endocarditis with Unusual Large Size Vegetation Involving the Mitral Valve

Antiphospholipid syndrome (APS) is an autoimmune hypercoagulable disorder characterized by thrombophilia, vascular thrombosis, and recurrent abortions associated with persistent antiphospholipid antibodies. APS may exist in its primary form, or more commonly is found to be associated with variety of rheumatic disorders, such as systemic lupus erythematosus. Cardiac involvement is not an uncommon complication in primary antiphospholipid patients. Libman-Sacks lesions are typically small, sessile, and wart-like, varying in size from 1-4 mm. Here we present an unusual case of a 37 year-old pregnant woman who suffered from heart failure associated with primary antiphospholipid syndrome and Libman-Sacks endocarditis, with large vegetations involving the mitral valve. The patient underwent mitral valve replacement with a mechanical prosthesis.