Isolated tricuspid Libman–Sacks endocarditis in a patient with systemic lupus erythematosus and antiphospholipid syndrome: case report

This case highlights (i) the need to consider LSE in culture-negative right-sided endocarditis among SLE/APS patients; (ii) the clinical utility of 3-D VCA to reconcile discrepant 2-D measures and substantiate surgical indication; (iii) peri-operative strategies after recent SAH (timing and anticoagulation); and (iv) rationale for a bioprosthesis in the low-flow tricuspid position given thrombogenicity of mechanical valves, alongside lifelong vitamin K antagonist therapy mandated by APS. Early multimodality imaging, Heart Team decision-making, timely surgery, and optimized immunomodulation can yield excellent outcomes.