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Case Reports
. 2019 Nov 10;12(11):e232057.
doi: 10.1136/bcr-2019-232057.

Atypical marantic endocarditis

Wilfred Ifeanyi Umeojiako  1 , Ioannis Kasouridis  2 , Robert Sargent  2 , Saqib Ghani  2
Affiliations
Case Reports

Atypical marantic endocarditis

Wilfred Ifeanyi Umeojiako et al. BMJ Case Rep. .

Abstract

Marantic endocarditis is a rare non-infectious endocarditis that mostly affects the aortic and mitral valves. It is often an autopsy finding that is most commonly seen in advanced malignancies thought to be due to a hypercoagulable state. When diagnosed antemortem, it typically presents with signs and symptoms of embolisation. We report a case of a 44-year-old Caucasian man with marantic endocarditis secondary to metastatic small cell lung cancer. Our patient presented with a short history of lower back pain with no signs/symptoms of embolisation, and a pansystolic murmur on initial physical examination. Serial blood cultures were negative and transthoracic echocardiography revealed vegetation on the posterior leaflet of the mitral valve. Further imaging in the form of MRI spine and CT thorax/abdomen/pelvis showed pulmonary lesions with liver and bony metastasis. Subsequent image-guided biopsy confirmed metastatic small cell lung cancer of T1N2M1c grade, which was treated with palliative chemotherapy and radiotherapy.

Keywords: cancer - see oncology; valvar diseases.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Chest radiograph on admission which was unremarkable.
Figure 2
Figure 2
Lumbar spine radiograph demonstrating straightening of the normal lumbar lordosis and minor posterior disc space narrowing at L5/S1 with no obvious lesions or fractures.
Figure 3
Figure 3
Focused view of the mitral valve in the apical three-chamber view demonstrating echogenic mass on the posterior leaflet (indicated by the blue arrow) and thickened anterior leaflet (indicated by the white arrow).
Figure 4
Figure 4
Parasternal short axis view demonstrating a thickened mitral valve (indicated by the arrows).
Figure 5
Figure 5
Apical four-chamber view with colour flow doppler demonstrating mitral regurgitation (indicated by the arrow).
Figure 6
Figure 6
MRI spine demonstrating widespread areas of low T1 and high T2 signal change throughout the spinal column, involving anterior and posterior elements (indicated by the arrows).
Figure 7
Figure 7
MRI spine demonstrating widespread areas of low T1 and high T2 signal change throughout the spinal column, involving anterior and posterior elements (indicated by the arrow).
Figure 8
Figure 8
CT scan of the thorax demonstrating multiple subpleural solid pulmonary lesions (indicated by the arrow).
Figure 9
Figure 9
CT scan of abdomen and pelvis demonstrating enlarged liver with multiple lesions (indicated by the arrows).
Figure 10
Figure 10
CT scan of abdomen and pelvis demonstrating significant para-aortic adenopathy (indicated by the arrow).
See this image and copyright information in PMC

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