Ischemic Stroke Revealing Libman-Sacks Endocarditis as the Initial Manifestation of Lupus Erythematosus With Secondary Antiphospholipid Syndrome: A Case Report

Libman-Sacks endocarditis (LSE), also known as nonbacterial thrombotic endocarditis (NBTE), is a rare condition characterized by noninfectious lesions on the heart valves with the deposition of thrombi. NBTE is most commonly linked to advanced malignancy, systemic lupus erythematosus, and antiphospholipid syndrome (APS). In many cases, NBTE is only diagnosed postmortem during autopsies, with embolization being the most frequent clinical manifestation. A high level of clinical suspicion is essential for diagnosis. Despite treatment involving anticoagulation and addressing the underlying etiology, the prognosis remains generally poor. We present the case of a 40-year-old woman admitted with new-onset dysarthria and upper motor weakness. Clinical evaluation, laboratory testing, and imaging revealed a stroke accompanied by valvular vegetations, which were linked to secondary APS. The patient was diagnosed with LSE and treated with anticoagulation. Neurological manifestations, such as embolization, are common in NBTE, often occurring in otherwise asymptomatic patients. Despite management of the acute condition, NBTE continues to be associated with high morbidity and mortality.