Recurrent ischaemic strokes as a first presentation of Libman–Sacks endocarditis with an atypically massive mitral vegetation resulting in severe valvular regurgitation: a case report

The management of young individuals with ischaemic stroke should include attention to atypical causes. Libman-Sacks endocarditis is usually associated with small vegetations and high thrombotic risk, usually managed medically with anticoagulation and treatment of underlying conditions. Our case was atypical, with the presence of a large vegetation causing significant valvular dysfunction, but it demonstrates that replacement with mechanical prostheses can be a feasible management strategy.