Libman-Sacks endocarditis is characterized by noninfectious vegetations on the cardiac valves of patients with systemic lupus erythematosus (SLE). Valvular abnormalities are found in about one third of patients with primary anitiphospholipid syndrome. SLE patients, with antiphospholipid antibodies, have a higher prevalence of valvular involvement than those without these antibodies. A 29 year old man was referred for evaluation of severe orthopnea. He presented with the clinical features of multi-organ failure (heart, lung and kidney). His serological and immunological findings were typical of a SLE flare up. His level of anticardiolipin antibody (IgG) was highly increased and his lupus anticoagulant was positive. A blood culture revealed no growth of bacterial organism. Transthoracic and transesophageal echocardiography showed non-mobile, verrucous vegetations on the anterior leaflet of the mitral valve, with moderate mitral regurgitation.