Marantic Endocarditis and Lung Adenocarcinoma with Brain Metastasis: A Diagnostic Conundrum

Abstract

Neurological symptoms such as headache and blurring of vision could be a manifestation of an underlying lung adenocarcinoma. The objective of this case report is to unveil the possible differentials and processes involved in the diagnosis of marantic endocarditis. A 57-year old male with blurring of vision and brain CT revealing multiple abscesses, sterile on culture, was treated as per guidelines. However, the patient had recurrent complaints that reinforced recurrent admissions and the patient was found to be COVID-19 positive during the pandemic when a routine test was performed in the emergency department. Suspicious lesions on the chest X-ray were further scrutinised and the patient was diagnosed with lung adenocarcinoma. To further investigate the sterile cultures in the brain, a cardiologist’s opinion was taken and a transthoracic echocardiogram was done, which was unremarkable. The increased suspicion for non-infective endocarditis necessitated a transoesophageal echocardiogram, which was positive for vegetations on the aortic valve. The patient was treated with anticoagulants and chemotherapy. In conclusion, in patients with CT findings of abscesses and sterile cultures, it is crucial to investigate the possible differentials in a meticulous fashion, as there could be an undiagnosed lung cancer in a non-smoker and there is a rare possibility of a sterile vegetation on the aortic valve, as was seen in the authors’ case.