A 38-year-old Hispanic woman with paradoxical embolism and Libman-Sacks endocarditis involving the tricuspid valve.

Libman-Sacks endocarditis is a well-described clinical entity in patients with systemic lupus erythematosus. Transesophageal echocardiography is the definitive imaging modality used in assessing cardiac valvular involvement in this disease process. Herein we describe a young Hispanic woman with systemic lupus erythematosus and multiple tricuspid valvular vegetations who developed splenic and cerebral infarctions while on optimal anticoagulation therapy with warfarin in the setting of a newly diagnosed patent foramen ovale. A review of the literature on Libman-Sacks endocarditis and patent foramen ovale closure is presented.