Multivalvular Involvement in a Middle-aged Male with Libman–Sacks Endocarditis

Libman–Sacks endocarditis (LSE) is an important cardiac manifestation of systemic lupus erythematosus. The mitral valve (MV) is the most commonly affected region, followed by the aortic valve (AV), whereas the tricuspid and pulmonary valves are rarely affected. The management of Libman–Sacks vegetation has significant challenges. In this case report, we present a 43-year-old male with a medical history of systemic lupus erythematosus, hypertension, and chronic kidney disease admitted to the Al-Nasiriya Heart Hospital. He suffered from dyspnea, orthopnea, cough, and unexplained hemoptysis for 4 days. He was found to have echogenic mass at the MV and AV with moderate-to-severe mitral regurgitation and moderate aortic regurgitation. The diagnosis of LSE was confirmed by a transesophageal echocardiogram. Initial investigation showed acute on chronic kidney injury that needed hemodialysis. He was starting on empirical therapy, diuretics, anticoagulants, and hydroxychloroquine. Despite maximum medical therapy, the patient continued to deteriorate and succumbed to kidney injury during a hemodialysis session in his last week of hospital stay.