A 37-year-old man on systemic immunosuppression for clinically and biochemically quiescent lupus nephritis, presented with left hemiparesis. Brain MRI was concerning for right sided embolic stroke. Workup was negative for atrial fibrillation, deep venous thrombosis, and heart failure. Transesophageal echocardiogram was remarkable for fixed mitral valve leaflet echodensities. In the absence of bacteremia and systemic signs of infection, and with a history of lupus, small vegetations on atrial and ventricular sides of mitral valve leaflets are suggestive of nonbacterial thrombotic endocarditis. Nonbacterial thrombotic vegetations are composed of fibrin deposits on otherwise-healthy valves. Mainstay of treatment is therapeutic anticoagulation with clinical and echocardiographic surveillance for moderate-severe mitral regurgitation.
McCuen A, Saad M, Terpstra EJ, Stys AT. Nonbacterial Thrombotic Mitral Valve Endocarditis Presenting as Embolic Stroke in a Young Patient with Lupus and Anti-phospholipid Syndrome. Aesculapius. 2021 Jul 20; 2(1):Article 5. Available from: https://red.library.usd.edu/aesculapius/vol2/iss1/5. Free full text article.