Case Of Nonbacterial Thrombotic Endocarditis Research Articles

Multi-valve Libman-Sacks's endocarditis-related multiple, massive and fatal systemic embolization. A case report and a review of diagnostic work-up.

We reported a case of non-bacterial thrombotic endocarditis (NBTE) in a 37-year-old woman who presented with signs and symptoms of cardio-embolic cerebral stroke caused by a prothrombotic state due to underlying advanced uterine cancer. Multimodal imaging, including 3D-ecocardiography, as well as laboratory and cultural tests, were critical in making the diagnosis. After starting anticoagulation therapy with low molecular weight heparin (LMWH), the patient underwent surgical aortic valve replacement due to worsening aortic valve function, initial left ventricle enlargement, increasing dimensions, and mobility of vegetations. Unfortunately, vegetations relapsed on the aortic valve bio-prosthesis as well as the mitral leaflets, resulting in a final picture of multi-valve NBTE. The fatal outcome was due to a massive multiple limb embolism, which resulted in leg amputations and septical complications. Starting with the case, we present a brief overview of the pathology's presentation, treatment, management, and prognosis, as well as the diagnostic work-up.

Nonbacterial thrombotic endocarditis with underlying ovarian carcinoma resolving with oncologic treatment.

The treatment of nonbacterial thrombotic endocarditisconsists of anticoagulation, surgical considerationand treatment of the underlying disease, most commonly lupus or malignancy. We report a case of nonbacterial thrombotic endocarditis presumably caused by underlying ovarian carcinoma that was controlled with anticoagulation and resolved with chemotherapy and surgical resection of the malignancy.

A Case of Non-Bacterial Thrombotic Endocarditis with Atypical Massive Vegitation

A Case of Non-Bacterial Thrombotic Endocarditis with Atypical Massive Vegitation

LIBMAN-SACKS ENDOCARDITIS AS THE INITIAL PRESENTATION OF METASTATIC GASTRIC ADENOCARCINOMA

TOPIC: Cardiovascular Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Nonbacterial thrombotic endocarditis (NBTE), "marantic", or "Libman-Sacks" endocarditis is a rare entity describing endocarditis that is non-infectious and usually secondary to advanced malignancy, systemic lupus erythematosus (SLE), or anti-phospholipid antibody syndrome. NBTE usually is found on autopsy, however some patients are diagnosed antemortem. If clinical signs and symptoms are suggestive, a high index of suspicion is needed to diagnosis NBTE. We present a case of endocarditis of unclear etiology that is later determined to be NBTE as the initial manifestation of metastatic gastric adenocarcinoma. CASE PRESENTATION: 63-year-old female with past medical history of recently diagnosed pulmonary embolism (PE) and multivessel deep vein thromboses (DVT's) on apixaban presented with dyspnea and chest tightness. She was found to have macrocytic anemia, bilateral pleural effusions, extensive lymphadenopathy, and splenic infarcts. Transesophageal echocardiogram showed severe mitral regurgitation with two large mitral valve vegetations suggestive of Libman-Sacks endocarditis. Four sets of blood cultures had no growth during the hospitalization, and other atypical causes of infectious endocarditis were ruled out. Rheumatological work-up was nonrevealing including SLE and anti-phospholipid antibody syndrome. Thoracentesis of right and left pleural effusions demonstrated metastatic adenocarcinoma, likely secondary to an upper gastrointestinal source. An esophagogastroduodenoscopy (EGD) was performed which showed an ulcerated lesion in the body of the stomach that was biopsied and showed poorly differentiated adenocarcinoma with signet ring cell features. Her hospital course was complicated by recurrent pleural effusions and clinical deterioration. Patient was subsequently transitioned to comfort measures and passed away shortly after. DISCUSSION: In most cases of nonbacterial thrombotic endocarditis, patients have a known pre-existing disease process such as SLE or malignancy to lead to a suspicion of NBTE. In this case, extensive investigation eventually led to the discovery of metastatic gastric cancer and the correct diagnosis of NBTE. Infectious causes, including atypical organisms and culture-negative endocarditis, must be ruled out to diagnose NBTE. CONCLUSIONS: When presented with endocarditis without a clear etiology, advanced malignancy must be considered. The correct diagnosis of NBTE is crucial and treatment of NBTE secondary to neoplasm consists of systemic anticoagulation as well as treatment directed against the underlying malignancy. REFERENCE #1: Deppisch LM, Fayemi AO. Non-bacterial thrombotic endocarditis: clinicopathologic correlations. Am Heart J 1976; 92:723. REFERENCE #2: el-Shami K, Griffiths E, Streiff M. Nonbacterial thrombotic endocarditis in cancer patients: pathogenesis, diagnosis, and treatment. Oncologist 2007; 12:518. DISCLOSURES: No relevant relationships by Michelle Helbig, source=Web Response No relevant relationships by Prashant Patel, source=Web Response

A Case of Nonbacterial Thrombotic Endocarditis Following Immune Checkpoint Inhibitor Treatment for Lung Adenocarcinoma

A Case of Nonbacterial Thrombotic Endocarditis Following Immune Checkpoint Inhibitor Treatment for Lung Adenocarcinoma

A Case of Nonbacterial Thrombotic Endocarditis with EGFR-mutated Lung Cancer Treated with Afatinib

A Case of Nonbacterial Thrombotic Endocarditis with EGFR-mutated Lung Cancer Treated with Afatinib

Mitral valve nonbacterial thrombotic endocarditis: a rare multi-surgery-tolerant survivor of Trousseau\u2019s syndrome

BackgroundFew previous reports have documented cases of nonbacterial thrombotic endocarditis associated with Trousseau’s syndrome for which surgery proved possible for both the primary tumor and the cardiac lesion. The effectiveness of direct oral anticoagulants in patients with Trousseau’s syndrome has also received scant attention.Case presentationA 69-year-old man with repeated episodes of cerebral infarction was diagnosed as having nonbacterial thrombotic endocarditis after mitral valve replacement surgery. Stroke recurred preoperatively under apixaban administration. A stomach biopsy also identified gastric adenocarcinoma, and gastric surgery was performed on the 40th postoperative day. The patient was discharged from the hospital and has been free of thromboembolism under a regime of subcutaneous heparin self-injection thereafter.ConclusionsWe have reported a rare multi-surgery-tolerant survivor of Trousseau’s syndrome in whom subcutaneous heparin injection was useful for preventing thromboembolic events over a long period.

Non-Bacterial Thrombotic Endocarditis in a Patient with Rheumatoid Arthritis.

Rheumatoid arthritis (RA) is frequently associated with various extra-joint complications. Although rare, thromboembolic complications are associated with high morbidity and mortality. We experienced a very rare case of nonbacterial thrombotic endocarditis (NBTE) and subsequent embolic stroke in a patient with RA. A 72-year-old male with a 15-year history of RA suddenly developed neurologic symptoms of vomiting and dizziness. Brain magnetic resonance imaging revealed recently developed multiple cerebellar and cerebral lacunar infarctions. Echocardiography showed a pulsating mitral valve vegetation involving the posterior cusp of the mitral valve leaflet, which was confirmed as NBTE. Immediate anti-coagulation therapy was started. The NBTE lesion disappeared in follow-up echocardiography after 4 weeks of anti-coagulation treatment.

臨床的に明らかな基礎疾患を認めなかった非細菌性血栓性心内膜炎の1例

臨床的に明らかな基礎疾患を認めなかった非細菌性血栓性心内膜炎の1例

Nonbacterial thrombotic endocarditis demonstrated by repeat echocardiography.

We report a case of nonbacterial thrombotic endocarditis (NBTE) in a patient with bladder cancer presenting with multiple cerebral infarctions. Initial transthoracic and transesophageal echocardiography did not show any abnormalities. However, repeat transthoracic and transesophageal echocardiography demonstrated a vegetation on the anterior leaflet of the mitral valve with mild mitral regurgitation and no evidence of leaflet destruction. Persistent high-grade fevers and leukocytosis were observed. The patient was suspected to have infective endocarditis. However, abdominal ultrasound and computed tomography scan revealed multiple metastatic masses, and serial blood cultures were negative. The patient was ultimately diagnosed with NBTE associated with multiple metastases of bladder cancer. This case suggests that even if echocardiography does not initially demonstrate any abnormalities in patients with embolism, it must be repeated at the recurrence of embolism, and that even if clinical signs of infection are documented, NBTE should be suspected in any cancer patient with thromboembolic events.

3D経食道心エコー検査により詳細に術前評価し，無症候の内に治療し得た非細菌性血栓性心内膜炎（nonbacterial thrombotic endocarditis）の1例

3D経食道心エコー検査により詳細に術前評価し，無症候の内に治療し得た非細菌性血栓性心内膜炎（nonbacterial thrombotic endocarditis）の1例

巨大骨盤内腫瘍に合併した非細菌性血栓性心内膜炎の1例

巨大骨盤内腫瘍に合併した非細菌性血栓性心内膜炎の1例

Non‐bacterial thrombotic endocarditis with systemic embolic events caused by adenomyosis

Non-bacterial thrombotic endocarditis is caused by a hypercoagulable state that is sometimes related to malignancy and this type of endocarditis associated with benign tumors has not yet been reported. In this study we report the first case of non-bacterial thrombotic endocarditis caused by adenomyosis, which is a benign gynecological condition.

A case of nonbacterial thrombotic endocarditis with difficult antemortem diagnosis

A case of nonbacterial thrombotic endocarditis with difficult antemortem diagnosis

Endocarditis trombótica no bacteriana y neoplasia pulmonar

A woman with the final diagnosis of non-bacterial thrombotic endocarditis associated to pulmonary adenocarcinoma is reported. She had had repetitive embolic strokes as the first manifestation, with vegetations on the mitral valve and without signs of acute infectious disease. The case is interesting because is an usually case of nonbacterial thrombotic endocarditis and the importance of an early diagnostic.

A Case of Nonbacterial Thrombotic Endocarditis in Small Ventricular Septal Defect

A Case of Nonbacterial Thrombotic Endocarditis in Small Ventricular Septal Defect

Acute aortic regurgitation caused by non-bacterial thrombotic endocarditis

A case of non-bacterial thrombotic endocarditis, which caused acute aortic regurgitation in a middle-aged, otherwise healthy woman, is presented. The diagnosis was confirmed with echocardiography and documented by a histopathological study of the excised aortic valve after operation for valve replacement.

Non-bacterial thrombotic endocarditis associated with malignant disease: a clinicopathological study of 16 cases.

Among 2627 necropsies performed in the Sir Charles Gairdner Hospital, Perth, over a period of 11 years, 16 cases of non-bacterial thrombotic endocarditis (NBTE) were found in patients with cancer (13 adenocarcinomas). The final stay in hospital of seven of these patients was complicated by a major embolic cerebral (six patients), or spinal cord (one patient), stroke. In all cases, the diagnosis of NBTE was made at necropsy. The aortic valve was affected in 10 patients, the mitral valve in five, and both the mitral and tricuspid valves in one. The diagnosis of NBTE should be considered in any patient with a known, or suspected, malignant neoplasm who suffers a stroke or other unexplained embolic events.

Nonbacterial thrombotic endocarditis in bone marrow transplant patients.

We reviewed the findings in 2381 consecutive autopsies, a series containing 91 bone marrow transplant (BMT) patients, and found 45 cases of nonbacterial thrombotic endocarditis (NBTE). The overall prevalence of NBTE was 1.9%. NBTE was present in seven BMT patients, for a prevalence of 7.7%. The rate of NBTE in BMT patients was significantly greater than the rate of NBTE in the general autopsy population (P less than 0.001). The frequency of NBTE was not increased in patients with the individual underlying diseases for which BMT was a possible treatment (the BMT candidate diseases [BMTCD]). When rates of NBTE were compared in patients with BMTCD, there was a significantly higher rate in patients who had received BMT than in those who had not (P less than 0.02). These findings indicate that NBTE occurs with greater frequency in BMT patients and that there may be features of the BMT regimen that predispose patients to develop NBTE. Although several factors related to BMT are discussed as potential contributors to the increased prevalence of NBTE, we were not able to demonstrate an association between NBTE and any single factor. Since NBTE is an important cause of arterial embolization, an awareness of the increased frequency of NBTE in BMT patients is important for clinicians who must interpret neurologic and other abnormalities in BMT recipients.

Non-bacterial thrombotic endocarditis: Clinicopathologic correlations

Sixty-five cases of nonbacterial thrombotic endocarditis (NBTE) were discovered at autopsy during a 10 year period--an incidence of 1.6 per cent in the adult autopsy population. In 51 cases, one or more malignant neoplasms were associated; adenocarcinoma represented the most frequent histologic type of related neoplasm. Coagulation abnormalities suggestive of disseminated intravascular coagulation (DIC) were present in 18.5 per cent of the cases. It is possible that both the valvular and peripheral intravascular thromboses in at least some cases of NBTE represent the abnormal coagulation of DIC. Arterial thrombosis with infarction occurred in many peripheral organs. Splenic and renal were most frequent, but cerebral and cardiac consequences were the most significant.