Nonbacterial thrombotic endocarditis as the sole manifestation of stage IV gastric cancer: a case report

INTRODUCTION: Nonbacterial thrombotic endocarditis is a very rare complication of malignancy and other hypercoagulable states. It describes the deposition of small sterile smooth or verrucoid vegetations on the valve leaflets, causing a clinical picture similar to that of bacterial endocarditis. The authors reported this case because this is a rare and unusual first manifestation of malignancy generally and of gastric cancer particularly, with only a few reports present in the literature. CASE PRESENTATION: The authors present a case of a 36-year-old Caucasian male with occult gastric cancer whose first and only manifestation was nonbacterial thrombotic endocarditis causing extensive multi-organ infarctions. CONCLUSIONS: An endocarditis not responsive to antibiotics should raise the suspicion of an occult malignancy. Differentiating between an infective endocarditis and a nonbacterial thrombotic endocarditis will cause a radical change in the management which will eventually affect the patient’s prognosis.