In SLE, mitral and tricuspid valvulitis with small, sterile vegetations, called LibmanSacks endocarditis is occasionally encountered. The lesions are small single or multiple, sterile, granular pink vegetations ranging from 1 to 4 mm in diameter. The lesions may be located on the undersurfaces of the atrioventricular valves, on the valvular endocardium, on the cords, or on the mural endocardium of atria or ventricles. An intense valvulitis may be present, characterized by fibrinoid necrosis of the valve substance that is often contiguous with the vegetation. Subsequent fibrosis and serious deformity can result that resembles chronic RHD and require surgery'.