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Gromke M, Beard B. Non-bacterial Thrombotic Endocarditis Related to Squamous Cell Carcinoma of the Cervix. Cureus 2023; 15:e42128. [PMID: 37602093 PMCID: PMC10437085 DOI: 10.7759/cureus.42128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 08/22/2023] Open
Abstract
We report the case of a 51-year-old woman who presented with multiple thrombotic events, including deep vein thrombosis, extensive pulmonary embolisms, myocardial infarction, and multiple ischemic strokes suggesting cardiogenic embolization. Recent history was significant for locally advanced squamous cell carcinoma of the cervix. Echocardiogram revealed large aortic valve vegetations in the absence of evidence of infectious endocarditis consistent with the diagnosis of non-bacterial thrombotic endocarditis (NBTE). This case is a rare presentation of NBTE associated with squamous cell carcinoma of the cervix.
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Affiliation(s)
- Megan Gromke
- Oncology, Edward Via College of Osteopathic Medicine, Blacksburg, USA
| | - Bryce Beard
- Radiation Oncology, Rapides Regional Medical Center, Alexandria, USA
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Hedin T, Haider M, Dedania B, Nguyen S. Esophageal Adenocarcinoma Causing Nonbacterial Thrombotic Endocarditis. Cureus 2023; 15:e39827. [PMID: 37397660 PMCID: PMC10314722 DOI: 10.7759/cureus.39827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2023] [Indexed: 07/04/2023] Open
Abstract
Nonbacterial thrombotic endocarditis (NBTE) is a rare condition that causes noninfectious vegetative lesions of heart valves. NBTE is generally seen in association with advanced malignancy. The patient in this case is a 54-year-old Caucasian male with a history of rate-controlled atrial fibrillation on rivaroxaban and morbid obesity post sleeve gastrectomy in 2021, who was admitted for atrial flutter. Transesophageal echocardiogram (TEE) cardioversion was planned due to difficulty in controlling the heart rate. During the procedure, cardioversion was aborted due to TEE findings of large mobile vegetation on the left atrial side of the posterior mitral valve leaflet. The patient was afebrile for the entirety of his 10-day hospital stay, and four sets of blood cultures were negative. Further workup with esophagogastroduodenoscopy (EGD) revealed a large partially obstructing ulcerated mass in the middle and lower third of the esophagus arising in the setting of Barrett's esophagus which was biopsy positive for esophageal adenocarcinoma. The patient was found to have advanced malignancy with metastases to the liver, adrenal glands, and perirectal lymph nodes. This case emphasizes the utilization of a TEE prior to cardioversion and also highlights the importance of EGD prior to and post gastric sleeve surgery to evaluate for esophageal cancer.
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Affiliation(s)
- Tosha Hedin
- Internal Medicine, HCA Healthcare University of South Florida Morsani College of Medicine, Tampa, USA
| | - Mahvish Haider
- Internal Medicine, HCA Healthcare University of South Florida Morsani College of Medicine, Tampa, USA
| | - Bhavtosh Dedania
- Gastroenterology, HCA Healthcare University of South Florida Morsani College of Medicine, Tampa, USA
| | - Son Nguyen
- Internal Medicine, HCA Healthcare University of South Florida Morsani College of Medicine, Tampa, USA
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Rahouma M, Khairallah S, Dabsha A, Elkharbotly IAMH, Baudo M, Ismail A, Korani OM, Hossny M, Dimagli A, Girardi LN, Mick SL, Gaudino M. Lung Cancer as a Leading Cause among Paraneoplastic Non-Bacterial Thrombotic Endocarditis: A Meta-Analysis of Individual Patients' Data. Cancers (Basel) 2023; 15:cancers15061848. [PMID: 36980734 PMCID: PMC10047261 DOI: 10.3390/cancers15061848] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/04/2023] [Accepted: 03/13/2023] [Indexed: 03/30/2023] Open
Abstract
Hypercoagulability is strongly associated with cancer and may result in non-bacterial thrombotic endocarditis (NBTE). The aim of our meta-analysis was to explore the demographics and characteristics of this condition in cancer. Databases were systematically searched. The outcomes were to identify the annual trend in premortem diagnosis among the entire cohort and different subgroups and to identify differences in characteristics and survival in the considered population. A total of 121 studies with 144 patients were included. The proportion of marantic endocarditis associated with lung cancer was 0.29 (95% CI, 0.21-0.37; p < 0.001), that associated with pancreatic cancer was 0.19 (95% CI, 0.13-0.27; p < 0.001), that associated with advanced cancer stage (metastasis) was 0.69 (95% CI, 0.61-0.76; p < 0.001), and that associated with adenocarcinoma was 0.65 (95% CI, 0.56-0.72; p < 0.001). Median and 6-month overall survival (OS) were 1.3 months and 32.3%, respectively, with 6-month OS of 20.8% vs. 37.0% in lung vs. other cancers, respectively (p = 0.06) and 42.9% vs. 31.1% among those who underwent intervention vs. those who did not (p = 0.07). Cases discovered in recent years had better survival (HR = 0.98 (95% CI, 0.96-0.99; p = 0.003). While cancer-associated NBTE is a rare entity, lung cancers were the most common tumor site and are frequently associated with more advanced and metastatic cancer stages. The prognosis is dismal, especially among lung cancers.
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Affiliation(s)
- Mohamed Rahouma
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10021, USA
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo 12613, Egypt
| | - Sherif Khairallah
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10021, USA
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo 12613, Egypt
| | - Anas Dabsha
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10021, USA
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo 12613, Egypt
| | - Ismail A M H Elkharbotly
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo 12613, Egypt
- General Surgery Department, Newham University Hospital, London E13 8SL, UK
| | - Massimo Baudo
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10021, USA
- Department of Cardiac Surgery, Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Amr Ismail
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10021, USA
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo 12613, Egypt
| | - Omnia M Korani
- Department of Medical Oncology, National Cancer Institute, Cairo University, Cairo 12613, Egypt
| | - Mohamed Hossny
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10021, USA
| | - Arnaldo Dimagli
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10021, USA
| | - Leonard N Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10021, USA
| | - Stephanie L Mick
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10021, USA
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10021, USA
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Pugalenthi LS, Ahmad M, Reddy S, Barkhane Z, Elmadi J, Satish Kumar L. Malignancy and Endocarditis: Divulging Into the Intertwined Association. Cureus 2022; 14:e24089. [PMID: 35573527 PMCID: PMC9098766 DOI: 10.7759/cureus.24089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2022] [Indexed: 12/02/2022] Open
Abstract
Cancer is an immunosuppressive disorder with characteristic features of unchecked cell growth, invasion, and sometimes thromboembolism leading to multiple systemic sequelae, including infective endocarditis. This article has compiled some of the crucial mechanisms by which infective endocarditis occurs in cancer patients, its risk factors, and the existing treatment interventions. It has focused on the necessity of being aware that these multiple pathogeneses are involved in the development of infective endocarditis (IE) in cancer patients, which would help delineate the risk factors associated with the condition and help physicians screen better for specific red flags. Identifying these risk factors and patient-oriented therapy, targeting the necessary elements such as causative organism, patient immune status, type of cancer, choosing evidence-based treatment modalities, and to improve the outcome of the disease in an already exasperating condition called cancer.
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Yongchai N, Venketasubramanian N, Tan KS. Uncommon Causes of Cardioembolic Stroke and Related Complications. Case Rep Neurol 2020; 12:176-177. [PMID: 33505291 PMCID: PMC7802466 DOI: 10.1159/000509506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 06/17/2020] [Indexed: 04/01/2024] Open
Affiliation(s)
- Nilanont Yongchai
- Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Kay Sin Tan
- Division of Neurology, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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