1
|
Ferrentino F, Campana S, Torri M, Rostagno C. Neuropsychiatric disorder as early clinical presentation of marantic endocarditis in patient with newly diagnosed poorly differentiated esophago-gastric junction adenocarcinoma: A case report. Clin Case Rep 2024; 12:e8710. [PMID: 38617073 PMCID: PMC11014799 DOI: 10.1002/ccr3.8710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/21/2024] [Accepted: 02/20/2024] [Indexed: 04/16/2024] Open
Abstract
Neuropsychiatric symptoms, depression, and progressive mental confusion should not be overlooked as onset symptoms of multiple cerebral ischemic lesions due to cardiac embolization. Comprehensive clinical evaluation due to progressive anemia led to the diagnosis of poorly differentiated adenocarcinoma of the esophagogastric junction as cause of embolizing nonbacterial mitral endocarditis.
Collapse
Affiliation(s)
| | | | | | - Carlo Rostagno
- Medicina Interna 3FirenzeItaly
- Dipartimento Medicina Sperimentale e ClinicaUniversità di FirenzeFirenzeItaly
| |
Collapse
|
2
|
Santiago LE, Kujundzic W, Wong S, Swaminath S, Aneja P. An Unusual Case of Nonbacterial Thrombotic Endocarditis Attributable to Malignancy. Cureus 2023; 15:e44734. [PMID: 37809183 PMCID: PMC10553845 DOI: 10.7759/cureus.44734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 10/10/2023] Open
Abstract
Nonbacterial thrombotic endocarditis (NBTE), also known as marantic endocarditis, is a condition characterized by the deposition of thrombi and fibrin on normal or degenerated cardiac valves in the absence of microorganisms. We report a case of a 60-year-old male with nonbacterial thrombotic endocarditis found on transesophageal echocardiogram (TEE) after a normal TEE just one month prior. Our patient presented with abdominal pain associated with poor appetite and unintentional 20-pound weight loss for one month. Chest computed tomography revealed the presence of a mass-like opacification in the right lung middle lobe with moderate pericardial effusions. A biopsy of the mass confirmed malignancy consistent with lung primary adenocarcinoma. Subsequently, during hospitalization, the patient developed left lower extremity pain. Arterial ultrasound showed occlusion of the distal left popliteal artery for which he underwent thrombectomy of the left superficial femoral artery, balloon angioplasty of the left posterior tibial artery, and left popliteal artery. Repeat TEE during current hospitalization revealed a large 2 cm vegetation on the noncoronary cusp of the aortic valve. Studies for infective endocarditis were unremarkable. Subsequently, he was treated with aortic valve replacement and anticoagulation. After discharge, he returned with bilateral occipital infarcts four days later and expired.
Collapse
Affiliation(s)
- Luis E Santiago
- Internal Medicine, Hospital Corporation of America (HCA) Florida Westside Hospital, Plantation, USA
| | - Winy Kujundzic
- Internal Medicine, Hospital Corporation of America (HCA) Florida Westside Hospital, Plantation, USA
| | - Stephanie Wong
- Internal Medicine, Hospital Corporation of America (HCA) Florida Westside Hospital, Plantation, USA
| | - Samyukta Swaminath
- Public Health, Emory University, Atlanta, USA
- Osteopathic Medicine, Nova Southeastern University, Davie, USA
| | - Pallavi Aneja
- Internal Medicine, Hospital Corporation of America (HCA) Florida Westside Hospital, Plantation, USA
| |
Collapse
|
3
|
Palicherla A, Pusapati S, Anugula D, Thandra A. Marantic Endocarditis in Metastatic Lung Adenocarcinoma. Methodist Debakey Cardiovasc J 2023; 19:100-103. [PMID: 37547896 PMCID: PMC10402816 DOI: 10.14797/mdcvj.1243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 06/29/2023] [Indexed: 08/08/2023] Open
Abstract
Marantic endocarditis is a rare condition associated with autoimmune disease, malignancy, and hypercoagulable states. It is characterized by sterile friable vegetations composed of fibrin and platelets that confer a high risk of systemic embolism. Here we showcase imaging that led to the diagnosis of an interesting case of marantic endocarditis secondary to metastatic malignancy.
Collapse
Affiliation(s)
| | - Suma Pusapati
- Creighton University School of Medicine, Omaha, Nebraska, US
| | | | | |
Collapse
|
4
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
Affiliation(s)
- Megan Gromke
- Oncology, Edward Via College of Osteopathic Medicine, Blacksburg, USA
| | - Bryce Beard
- Radiation Oncology, Rapides Regional Medical Center, Alexandria, USA
| |
Collapse
|
5
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
6
|
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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
7
|
Mandal AK, Heer RS, Petrou M, Missouris CG. Recurrent Nonbacterial Thrombotic Endocarditis and Primary Antiphospholipid Antibody Syndrome. Cureus 2023; 15:e36275. [PMID: 37073185 PMCID: PMC10105903 DOI: 10.7759/cureus.36275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 03/19/2023] Open
Abstract
In 2015, a 37-year-old man was referred for evaluation of hypertension and was found to have a mobile structure on the posterior mitral valve leaflet on echocardiography. Laboratory investigations yielded a diagnosis of primary antiphospholipid antibody syndrome (APLS). He underwent excision of the lesion and mitral valve repair. Histology confirmed the diagnosis of nonbacterial thrombotic endocarditis (NBTE). The patient was anticoagulated with warfarin up until 2018, which was substituted for rivaroxaban because of an erratic international normalised ratio. Serial echocardiography up to 2020 was unremarkable. In 2021, he presented with breathlessness and peripheral oedema. Echocardiography demonstrated large vegetation on both mitral valve leaflets. At the operation, vegetations were also evident on the left and noncoronary cusps of the aortic valve and he underwent mechanical aortic and mitral valve replacement. Histology confirmed NBTE. The case is unusual and highlights recurrent NBTE requiring re-do valve surgery.
Collapse
Affiliation(s)
- Amit K Mandal
- Cardiology/Internal Medicine, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Slough, GBR
| | - Randeep S Heer
- Cardiology/Internal Medicine, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Slough, GBR
| | - Mario Petrou
- Cardiac Surgery, The Royal Brompton and Harefield NHS Foundation Trust, London, GBR
| | - Constantinos G Missouris
- Cardiology, University of Nicosia Medical School, Nicosia, CYP
- Cardiology/Internal Medicine, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Slough, GBR
| |
Collapse
|
8
|
Muacevic A, Adler JR, Arad A, Kalmnovich G, Herzog E. Multi-Valvular Non-bacterial Thrombotic Endocarditis Causing Sequential Pulmonary Embolism, Myocardial Infarction, and Stroke: A Case Report and Literature Review. Cureus 2022; 14:e32261. [PMID: 36620810 PMCID: PMC9815786 DOI: 10.7759/cureus.32261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 12/12/2022] Open
Abstract
Non-bacterial thrombotic endocarditis is an uncommon entity that tends to be related to malignancy or rheumatological disorders. The diagnosis is complex and requires a high index of suspicion. It commonly causes recurrent emboli; however, coronary embolism remains an infrequently reported entity. Herein we report a unique case of sequential pulmonary embolism, ST-elevation myocardial infarction (MI), and stroke associated with multi-valvular non-bacterial thrombotic endocarditis. The cornerstone of management is treating the underlying cause and anticoagulation therapy. Surgical treatment should be considered in patients with acute heart failure secondary to valvular dysfunction and recurrent thromboembolism despite proper anticoagulation. We have performed an extensive literature search and found nine cases of established antemortem diagnosis of myocardial infarction secondary to non-bacterial thrombotic endocarditis, and we reviewed them according to cause, treatment, and outcome.
Collapse
|
9
|
Restelli D, Trio O, Poleggi C, Piccione MC, Manganaro R, Certo G, Zito C, Andò G. Nonbacterial Thrombotic Endocarditis with Atypical Presentation as Overt Congestive Heart Failure. J Cardiovasc Echogr 2022; 32:225-228. [PMID: 36994120 PMCID: PMC10041397 DOI: 10.4103/jcecho.jcecho_42_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 08/25/2022] [Indexed: 03/31/2023] Open
Abstract
Nonbacterial thrombotic endocarditis (NBTE) is a form of endocarditis associated with malignancy or autoimmune disorders. Diagnosis remains a challenge as patients are often asymptomatic up to embolic events or rarely, valve dysfunction. We report a case of NBTE with uncommon clinical presentation and identified with multimodal echocardiography. An 82-year-old man presented to our outpatient clinic reporting dyspnea. Past medical history included hypertension, diabetes, kidney disease, and unprovoked deep-vein thrombosis. On physical examination, he was apyretic, mildly hypotensive, and hypoxemic, had a systolic murmur and lower limbs edema. Transthoracic echocardiography revealed severe mitral regurgitation due to verrucous thickening of the free margin of both leaflets, increased pulmonary pressure, and dilated inferior vena cava. Multiple blood cultures were negative. Transesophageal echocardiography confirmed "thrombotic" thickening of mitral leaflets. Nuclear investigations were highly suggestive of multi-metastatic pulmonary cancer. We did not further proceed with the diagnostic workup and prescribed palliative care. Lesions seen on echocardiography were suggestive of NBTE: they involved both sides of mitral leaflets, close to the edges, had irregular shape and echo density, a broad base, and no independent motion. Criteria for infective endocarditis were not met and the final diagnosis was paraneoplastic NBTE due to underlying lung cancer. We remark the lack of definitive recommendations about the treatment of NBTE and the only role of anticoagulation to prevent systemic embolism. We have reported a case of NBTE presenting with atypical symptoms and likely related to the prothrombotic state induced by underlying lung cancer. Provided the unconclusive microbiological tests, multimodal imaging has played a crucial role in the final diagnosis.
Collapse
Affiliation(s)
- Davide Restelli
- Department of Clinical and Experimental Medicine, Section of Cardiology, University of Messina, Azienda Ospedaliera Universitaria Policlinico “Gaetano Martino,” Messina, Italy
| | - Olimpia Trio
- Department of Clinical and Experimental Medicine, Section of Cardiology, University of Messina, Azienda Ospedaliera Universitaria Policlinico “Gaetano Martino,” Messina, Italy
| | - Cristina Poleggi
- Department of Clinical and Experimental Medicine, Section of Cardiology, University of Messina, Azienda Ospedaliera Universitaria Policlinico “Gaetano Martino,” Messina, Italy
| | - Maurizio Cusmà Piccione
- Department of Clinical and Experimental Medicine, Section of Cardiology, University of Messina, Azienda Ospedaliera Universitaria Policlinico “Gaetano Martino,” Messina, Italy
| | - Roberta Manganaro
- Department of Clinical and Experimental Medicine, Section of Cardiology, University of Messina, Azienda Ospedaliera Universitaria Policlinico “Gaetano Martino,” Messina, Italy
| | - Giuseppe Certo
- Department of Clinical and Experimental Medicine, Section of Cardiology, University of Messina, Azienda Ospedaliera Universitaria Policlinico “Gaetano Martino,” Messina, Italy
| | - Concetta Zito
- Department of Clinical and Experimental Medicine, Section of Cardiology, University of Messina, Azienda Ospedaliera Universitaria Policlinico “Gaetano Martino,” Messina, Italy
| | - Giuseppe Andò
- Department of Clinical and Experimental Medicine, Section of Cardiology, University of Messina, Azienda Ospedaliera Universitaria Policlinico “Gaetano Martino,” Messina, Italy
| |
Collapse
|
10
|
Manian N, Arunachalam P, El Nihum LI, Al Abri Q, Barrios R, Chamsi-Pasha M, Ramchandani M. Atypical Presentation of Marantic Endocarditis. Methodist Debakey Cardiovasc J 2022; 18:45-47. [PMID: 35891698 PMCID: PMC9284980 DOI: 10.14797/mdcvj.1105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/02/2022] [Indexed: 11/22/2022] Open
Abstract
We describe a 39-year-old man referred for surgical aortic valve replacement for severe symptomatic aortic stenosis. Intraoperative inspection was unexpectedly consistent with marantic endocarditis. Pathology confirmed nonbacterial thrombotic endocarditis. We present high-resolution intraoperative, diagnostic, and pathology images of nonbacterial thrombotic endocarditis in a patient with antiphospholipid syndrome with atypical presentation.
Collapse
Affiliation(s)
- Nina Manian
- Texas A&M College of Medicine, Bryan, Texas, US
| | | | | | - Qasim Al Abri
- Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
| | | | - Mohammed Chamsi-Pasha
- Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
| | - Mahesh Ramchandani
- Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
| |
Collapse
|
11
|
Mohamed W, Ahmed A, Mansour S, Zlocha V. Left ventricular free-wall rupture: An unusual presentation of non-bacterial thrombotic endocarditis. Perfusion 2022:2676591221092313. [PMID: 35575314 DOI: 10.1177/02676591221092313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Non-bacterial thrombotic endocarditis (NBTE) is a rare, often asymptomatic, condition. A 55-year-old woman presented with hemiparesis, facial palsy and chest pain. After urgent investigation, she was referred as a case of type A aortic dissection complicated by tamponade, myocardial infarction and stroke. Review of her imaging identified haemopericardium but no dissection, and emergency surgery proceeded considering her unstable condition. She underwent an emergency repair of left-ventricular free-wall rupture and excision of an aortic valve vegetation. Postoperative investigations confirmed a diagnosis of NBTE in the setting of a plexiform neurofibroma, and she was discharged 9 weeks later with residual neurological symptoms. This case poses a previously unreported acute presentation of NBTE and highlights the complexities in its diagnosis and management.
Collapse
Affiliation(s)
- Walid Mohamed
- Department of Cardiac Surgery, Glenfield Hospital, Leicester, UK
| | - Aamer Ahmed
- Cardiothoracic Anaesthesia and Critical Care, Glenfield Hospital, Leicester, UK
| | - Sherif Mansour
- Department of Cardiac Surgery, Glenfield Hospital, Leicester, UK
| | - Viktor Zlocha
- Department of Cardiac Surgery, Glenfield Hospital, Leicester, UK
| |
Collapse
|
12
|
Ahmad A, Arghami A, El-Am EA, Foley TA, Kurmann RD, Klarich KW. Case Report: A Tale of a Cardiac Mass: Looks Like a Papillary Fibroelastoma, Acts Like a Non-bacterial Thromboendocarditis. Front Cardiovasc Med 2021; 8:782926. [PMID: 34869697 PMCID: PMC8632806 DOI: 10.3389/fcvm.2021.782926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 10/25/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction: Benign cardiac tumors and tumor like conditions are a heterogeneous collection of mass lesions that vary widely in their characteristics, such as presentation, size, and location. In some instances, these tumors are found incidentally, and therefore a broad differential diagnosis should be considered. Case: An elderly male with significant unintentional weight loss and a high risk for cancer presented with an incidental valvular cardiac mass. The mass was thought to be a non-bacterial thromboendocarditis on initial clinical evaluation. After multiple imaging modalities, the mass was suspected to be a papillary fibroelastoma (PFE), which was resected due to high stroke risk and multiple previous chronic infarcts on brain MRI. Conclusion: This case highlights the need for a comprehensive cardiac evaluation of a valvular tumor to discern the etiology and rule out other underlying pathophysiological processes that may require alternative interventions to cardiac surgery.
Collapse
Affiliation(s)
- Ali Ahmad
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States.,Department of Internal Medicine, Saint Louis University School of Medicine, Saint Louis, MO, United States
| | - Arman Arghami
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, United States
| | - Edward A El-Am
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States.,Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Thomas A Foley
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States.,Division of Cardiovascular Radiology, Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Reto D Kurmann
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States.,Heart Center, Kantonsspital Luzern, Lucerne, Switzerland
| | - Kyle W Klarich
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| |
Collapse
|
13
|
Savarapu P, Abdelazeem B, Isa S, Baral N, Hassan M. Cancer-Related Non-Bacterial Thrombotic Endocarditis Presenting as Acute Ischemic Stroke. Cureus 2021; 13:e14953. [PMID: 34123650 PMCID: PMC8190829 DOI: 10.7759/cureus.14953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 11/05/2022] Open
Abstract
Non-bacterial thrombotic endocarditis (NBTE), also known as marantic endocarditis, is a rare form of noninfectious endocarditis presenting with thromboembolism including ischemic cerebral stroke. It is mostly associated with advanced malignancy and characterized by the presence of sterile vegetation on heart valves. The diagnosis is usually based on vegetations seen on an echocardiogram, with negative blood cultures suggesting a noninfectious etiology. The treatment for this condition includes systemic anticoagulation. In this report, we discuss the case of a 61-year-old Caucasian female who presented to our facility with an ischemic stroke. She was found to have vegetations on the mitral valve with negative blood cultures. Further studies revealed metastatic pancreatic cancer. The patient's condition improved following in-hospital management, and she was discharged home for outpatient follow-up and treatment. Through this report, we highlight the importance of considering a search for malignancy in patients presenting with these clinical features. Early diagnosis and prompt management are critical to reduce the complications of NBTE and improve the patients' quality of life.
Collapse
Affiliation(s)
- Pramod Savarapu
- Internal Medicine, McLaren Flint/Michigan State University, Flint, USA
| | - Basel Abdelazeem
- Internal Medicine, McLaren Flint/Michigan State University, Flint, USA
| | - Sakiru Isa
- Internal Medicine, McLaren Flint/Michigan State University, Flint, USA
| | - Nischit Baral
- Internal Medicine, McLaren Flint/Michigan State University, Flint, USA
| | - Mustafa Hassan
- Cardiology, Michigan State University College of Human Medicine, Flint, USA
| |
Collapse
|
14
|
Cheung B, Shivkumar A, Ahmed AS. Embolic Showering from Non-Bacterial Thrombotic Endocarditis and Adenocarcinoma of the Lung. Eur J Case Rep Intern Med 2020; 7:001798. [PMID: 33083358 DOI: 10.12890/2020_001798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 06/18/2020] [Indexed: 11/05/2022] Open
Abstract
Background Non-bacterial thrombotic endocarditis (NBTE) is a paraneoplastic phenomenon with sterile vegetations. It is associated with adenocarcinoma and can shower emboli, which can be the presenting symptom. Case Presentation A 44-year-old woman with adenocarcinoma of the lung presented with chest pain, left hand weakness, and ataxia due to repeated embolic showering from NBTE to the central nervous system (CNS) and spleen. Conclusion NBTE is a rare condition that should be on the differential diagnosis in patients with culture-negative endocarditis and a history of adenocarcinoma. LEARNING POINTS Differentiating non-bacterial thrombotic endocarditis (NBTE) from infective endocarditis can be a diagnostic challenge due to slow growing organisms; laboratory findings that suggest NBTE include the lack of leucocytosis, normal C-reactive protein, negative blood culture sets, and positive antiphospholipid antibodies.Serial transesophageal echocardiogram (TEE) should be performed if suspicion of valvular vegetations is high despite the initial TEE showing no vegetations.The mainstay treatment of NBTE is anticoagulation and addressing the underlying condition.
Collapse
Affiliation(s)
- Brian Cheung
- Saint Bernards Healthcare, Jonesboro, Arkansas, USA
| | | | | |
Collapse
|
15
|
Perrone F, Biagi A, Facchinetti F, Bozzetti F, Ramelli A, Vezzani A, Manca T, Gnetti L, Majori M, Alfieri V, Tiseo M. Systemic thromboembolism from a misdiagnosed non-bacterial thrombotic endocarditis in a patient with lung cancer: A case report. Oncol Lett 2020; 20:194. [PMID: 32952663 PMCID: PMC7479525 DOI: 10.3892/ol.2020.12056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 03/05/2020] [Indexed: 12/03/2022] Open
Abstract
Thromboembolic events are frequent in patients with cancer, commonly involving the venous and pulmonary circulation. The arterial system is rarely implicated in embolism and, when involved, a cardiogenic origin should always be excluded. In the present study, a case of a patient who developed multiple embolic events concomitantly with the diagnosis of locally-advanced non-small cell lung cancer with high expression levels of programmed death-ligand 1 (PD-L1) in >50% of tumor cells is reported. A cardiac defect interpreted as a patent foramen ovale required low molecular weight heparin administration. Despite the anti-coagulant therapy, before first-line anticancer treatment with pembrolizumab immunotherapy could be administered due to high PD-L1 expression levels, a new hospitalization was required due to the onset of novel ischemic manifestation. New transthoracic and transesophageal echocardiography revealed a previously misdiagnosed vegetation of the mitral valve that caused systemic embolization. The lack of any sign of infection led to the diagnosis of a non-bacterial thrombotic endocarditis (NBTE), whose embolic sprouting gave rise to the widespread ischemic events. No active anticancer treatment was feasible due to the rapid progression of the disease. NBTE can evolve quickly, eventually preventing any chance of treatment targeting the primary cause, which in the present study was lung cancer. If NBTE can be correctly diagnosed sooner then there may be the potential for anticancer therapy that does not worsen the hypercoagulability state, thus improving cancer-associated survival.
Collapse
Affiliation(s)
- Fabiana Perrone
- Medical Oncology Unit, University Hospital of Parma, I-43126 Parma, Italy
| | - Andrea Biagi
- Cardiology Department, University Hospital of Parma, I-43126 Parma, Italy
| | - Francesco Facchinetti
- Medical Oncology Unit, University Hospital of Parma, I-43126 Parma, Italy.,National Institute of Health and Medical Research, Gustave Roussy Cancer Campus, University of Paris-Saclay, 94800 Villejuif, France
| | | | - Andrea Ramelli
- Cardiac Surgery Intensive Care Unit, University of Parma, I-43126 Parma, Italy
| | - Antonella Vezzani
- Cardiac Surgery Intensive Care Unit, University of Parma, I-43126 Parma, Italy
| | - Tullio Manca
- Cardiac Surgery Intensive Care Unit, University of Parma, I-43126 Parma, Italy
| | - Letizia Gnetti
- Unit of Pathology, University of Parma, I-43126 Parma, Italy
| | - Maria Majori
- Unit of Pulmonology and Thoracic Endoscopy, University of Parma, I-43126 Parma, Italy
| | - Veronica Alfieri
- Unit of Respiratory Disease and Lung Function, University of Parma, I-43126 Parma, Italy
| | - Marcello Tiseo
- Medical Oncology Unit, University Hospital of Parma, I-43126 Parma, Italy.,Department of Medicine and Surgery, University of Parma, I-43126 Parma, Italy
| |
Collapse
|
16
|
Dietrich M, Bois M, Ferrufino R, Cobey F, Mankad R. A Tale of Two Valves: Bioprosthetic Aortic Valve Obstruction in Systemic Lupus Erythematosus and Antiphospholipid Antibody Syndrome. J Cardiothorac Vasc Anesth 2020; 34:3462-3466. [PMID: 32800619 DOI: 10.1053/j.jvca.2020.07.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 12/18/2022]
Abstract
Patients with systemic lupus erythematosus (SLE) and antiphospholipid antibody syndrome (APLAS) are at risk for cardiac manifestations, specifically valvular heart disease requiring valve replacement. Bioprosthetic valve endocarditis is an important cause of valve failure, and it is important to keep a wide differential, especially in patients with preexisting SLE and APLAS. In this E-challenge, 2 cases of bioprosthetic aortic valve endocarditis are presented; 1 case describes infective bacterial endocarditis on an aortic prosthesis and the second describes a patient with SLE and APLAS who developed bioprosthetic valve obstruction secondary to vegetations, consistent with nonbacterial endocarditis and thrombus. Etiologies for bioprosthetic valve obstruction and evaluation by echocardiography are explored. The comparison between these 2 cases specifically highlights the importance of keeping a wide differential in endocarditis, prosthetic valve vegetations, and bioprosthetic valve obstruction.
Collapse
|
17
|
Gundersen H, Moynihan B. An Uncommon Cause of Stroke: Non-bacterial Thrombotic Endocarditis. J Stroke Cerebrovasc Dis 2016; 25:e163-4. [PMID: 27449112 DOI: 10.1016/j.jstrokecerebrovasdis.2015.11.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 08/11/2015] [Accepted: 11/05/2015] [Indexed: 12/15/2022] Open
Abstract
Our objective is to present the case of an uncommon but probably under-recognized cause of stroke: Non-bacterial thrombotic endocarditis (NBTE). A 59-year-old man presented to our hospital with multiple bihemispheric infarcts despite taking rivaroxaban for pulmonary emboli diagnosed 2 weeks earlier. The patient's symptoms progressed quickly and he died within a week of his initial presentation despite attempts at neuroradiologically guided clot retrieval and early recognition and treatment of disseminated intravascular coagulation. On postmortem examination it was discovered that he had an undiagnosed squamous cell adenocarcinoma of the lung and NBTE. NBTE is difficult to diagnose and difficult to treat. It is associated with a mortality rate and is often not diagnosed until autopsy. However there are case reports in the literature where NBTE has been successfully treated. Early recognition and prompt treatment of the underlying disease process is the essential first step.
Collapse
|