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Case Reports
. 2020 Feb 10;4(1):1-5.
doi: 10.1093/ehjcr/ytaa008. eCollection 2020 Feb.

Non-bacterial thrombotic endocarditis in the context of pulmonary adenocarcinoma: a case report

Christoph C Kaufmann  1 , Emil Wessely  1 , Kurt Huber  1   2
Affiliations
Case Reports

Non-bacterial thrombotic endocarditis in the context of pulmonary adenocarcinoma: a case report

Christoph C Kaufmann et al. Eur Heart J Case Rep. .

Abstract

Background: Non-bacterial thrombotic endocarditis (NBTE) is a rare condition, usually observed in association with malignancy, lupus erythematosus, or antiphospholipid syndrome. Diagnosis of NBTE remains a challenge as patients are often asymptomatic up to their first thromboembolic event. While there is no randomized data available for the guidance of treatment in NBTE, effective anticoagulation remains the main focus in the management of affected patients.

Case summary: A 44-year-old female patient without a significant medical history presented to the emergency department with a new numbness of her right hand. Magnetic resonance imaging scans facilitated the diagnosis of supratentorial stroke. Within the next 3 months, the patient had multiple thromboembolic events, including multiple strokes, pulmonary embolism, and renal/splenic infarction. Echocardiographic examination revealed large, transient vegetations of the aortic valve with concomitant aortic regurgitation. In addition, an incidental, pulmonary non-small-cell adenocarcinoma was found during the diagnostic work-up. Infective endocarditis was excluded by several negative blood cultures and missing signs of infection. Hence, the diagnosis of NBTE secondary to malignancy was made.

Discussion: We present a rare case of NBTE in the context of pulmonary adenocarcinoma. The adequate treatment of malignancy and effective anticoagulation are the main treatment options.

Keywords: Anticoagulation; Case report; Malignancy; Non-bacterial thrombotic endocarditis; Thromboembolism.

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Figures

Figure 1
Figure 1
Echocardiographic findings. (A) Transoesophageal echocardiography—baseline: 8 × 4 mm vegetation of right coronary aortic valve cusp; moderate aortic regurgitation; (B) transthoracic echocardiography—follow-up 1: regular aortic valve; minimal aortic regurgitation; and (C) transthoracic echocardiography—follow-up 2: 5 × 3 mm vegetation of non-coronary aortic valve cusp.
Figure 2
Figure 2
Imaging of thromboembolic events/pulmonary carcinoma. (A) Magnetic resonance imaging—head: bilateral cerebellar lesions consistent with stroke secondary to thromboemblosim. (B) Computed tomography-pulmonary angiogram: bilateral peripheral pulmonary embolism—right-sided lesion depicted. (C) Positron emission tomography–computed tomography: intense radiotracer uptake in the right lung consistent with non-small-cell lung cancer. (D) Magnetic resonance imaging—head: 5 cm right parieto-dorsal hyperintense lesion consistent with subinsular stroke. (E) Magnetic resonance imaging—abdomen: wedge-shaped defect in the spleen consistent with splenic infarction. (F) Magnetic resonance imaging—abdomen: perfusion defect of left kidney consistent with renal infarction.
None
See this image and copyright information in PMC

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