Non-bacterial thrombotic endocarditis: a rare presentation and literature review

Abstract

A 66-year-old woman with a remote history of breast cancer and prior tobacco use presented to the hospital with chest pain. She was found to have an elevated troponin consistent with a diagnosis of a non-ST segment elevation myocardial infarction (NSTEMI). A left heart catheterisation revealed non-obstructive coronary disease, and subsequent transthoracic and transoesophageal echocardiograms demonstrated vegetations on both the mitral and aortic valves. Multiple blood cultures showed no growth raising suspicion for non-bacterial thrombotic endocarditis (NBTE). A CT of the chest, abdomen and pelvis was obtained that was consistent with metastatic pancreatic cancer. Her hospital course was complicated by recurrent embolic strokes leading to a rapid clinical deterioration. As a result, she was transitioned to comfort measures and passed away shortly thereafter. To our knowledge, this is the first reported case of an NSTEMI as the initial presentation of NBTE due to underlying malignancy.

Keywords: cardiovascular medicine; cardiovascular system; oncology; valvar diseases; venous thromboembolism.

Figure 1

A large oscillating vegetation noted on the mitral valve on transesophageal echocardiography.

Figure 2

Multiple vegetations noted on the both cusps of the mitral valve on transoesophageal echocardiography.

Figure 3

A large vegetation noted on the non-coronary cusp of the aortic valve on transoesophageal echocardiography.

Figure 4

2.3×2.2 cm mass noted on the pancreatic head on CT abdomen.