BACKGROUND: Systemic lupus erythematosus (SLE) is a systemic disease with various cardiac and non-cardiac presentations. We present the case of a young woman with odd presentation of SLE mistakenly identified as a valve abscess that was scheduled for surgery.

CASE REPORT: This 35-year-old woman presented with rapid progression of aortic stenosis, and the transesophageal echocardiography report showed a misdiagnosed aortic web (congenital) and aortic wall abscess. She was scheduled for surgery as a case of subacute bacterial endocarditis (SBE) and aortic abscess, despite lack of fever.

CONCLUSIONS: Cardiovascular involvement should be considered in any SLE patient, especially those with high SLE scores, even with negative antiphospholipid antibody. Cardiovascular involvement may be odd and misleading in some cases, which may warrant especial attention and experienced caregivers for clinical reasoning and proper management.

Keywords: Aortic Stenosis, Subvalvular, Cardiac Valve Annuloplasty, Endocarditis, Subacute Bacterial, Lupus Vasculitis, Central Nervous System, Diagnosis, Differential, Diagnostic Errors, Echocardiography, Transesophageal, Heart Valve Diseases, Lupus Erythematosus, Systemic