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Non-bacterial thrombotic endocarditis in the context of pulmonary adenocarcinoma: a case report

BACKGROUND: Non-bacterial thrombotic endocarditis (NBTE) is a rare condition, usually observed in association with malignancy, lupus erythematosus, or antiphospholipid syndrome. Diagnosis of NBTE remains a challenge as patients are often asymptomatic up to their first thromboembolic event. While the...

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Autores principales: Kaufmann, Christoph C, Wessely, Emil, Huber, Kurt
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7047059/
https://www.ncbi.nlm.nih.gov/pubmed/32128491
http://dx.doi.org/10.1093/ehjcr/ytaa008
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author Kaufmann, Christoph C
Wessely, Emil
Huber, Kurt
author_facet Kaufmann, Christoph C
Wessely, Emil
Huber, Kurt
author_sort Kaufmann, Christoph C
collection PubMed
description BACKGROUND: Non-bacterial thrombotic endocarditis (NBTE) is a rare condition, usually observed in association with malignancy, lupus erythematosus, or antiphospholipid syndrome. Diagnosis of NBTE remains a challenge as patients are often asymptomatic up to their first thromboembolic event. While there is no randomized data available for the guidance of treatment in NBTE, effective anticoagulation remains the main focus in the management of affected patients. CASE SUMMARY: A 44-year-old female patient without a significant medical history presented to the emergency department with a new numbness of her right hand. Magnetic resonance imaging scans facilitated the diagnosis of supratentorial stroke. Within the next 3 months, the patient had multiple thromboembolic events, including multiple strokes, pulmonary embolism, and renal/splenic infarction. Echocardiographic examination revealed large, transient vegetations of the aortic valve with concomitant aortic regurgitation. In addition, an incidental, pulmonary non-small-cell adenocarcinoma was found during the diagnostic work-up. Infective endocarditis was excluded by several negative blood cultures and missing signs of infection. Hence, the diagnosis of NBTE secondary to malignancy was made. DISCUSSION: We present a rare case of NBTE in the context of pulmonary adenocarcinoma. The adequate treatment of malignancy and effective anticoagulation are the main treatment options.
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spelling pubmed-70470592020-03-03 Non-bacterial thrombotic endocarditis in the context of pulmonary adenocarcinoma: a case report Kaufmann, Christoph C Wessely, Emil Huber, Kurt Eur Heart J Case Rep Case Reports BACKGROUND: Non-bacterial thrombotic endocarditis (NBTE) is a rare condition, usually observed in association with malignancy, lupus erythematosus, or antiphospholipid syndrome. Diagnosis of NBTE remains a challenge as patients are often asymptomatic up to their first thromboembolic event. While there is no randomized data available for the guidance of treatment in NBTE, effective anticoagulation remains the main focus in the management of affected patients. CASE SUMMARY: A 44-year-old female patient without a significant medical history presented to the emergency department with a new numbness of her right hand. Magnetic resonance imaging scans facilitated the diagnosis of supratentorial stroke. Within the next 3 months, the patient had multiple thromboembolic events, including multiple strokes, pulmonary embolism, and renal/splenic infarction. Echocardiographic examination revealed large, transient vegetations of the aortic valve with concomitant aortic regurgitation. In addition, an incidental, pulmonary non-small-cell adenocarcinoma was found during the diagnostic work-up. Infective endocarditis was excluded by several negative blood cultures and missing signs of infection. Hence, the diagnosis of NBTE secondary to malignancy was made. DISCUSSION: We present a rare case of NBTE in the context of pulmonary adenocarcinoma. The adequate treatment of malignancy and effective anticoagulation are the main treatment options. Oxford University Press 2020-02-10 /pmc/articles/PMC7047059/ /pubmed/32128491 http://dx.doi.org/10.1093/ehjcr/ytaa008 Text en © The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Case Reports
Kaufmann, Christoph C
Wessely, Emil
Huber, Kurt
Non-bacterial thrombotic endocarditis in the context of pulmonary adenocarcinoma: a case report
title Non-bacterial thrombotic endocarditis in the context of pulmonary adenocarcinoma: a case report
title_full Non-bacterial thrombotic endocarditis in the context of pulmonary adenocarcinoma: a case report
title_fullStr Non-bacterial thrombotic endocarditis in the context of pulmonary adenocarcinoma: a case report
title_full_unstemmed Non-bacterial thrombotic endocarditis in the context of pulmonary adenocarcinoma: a case report
title_short Non-bacterial thrombotic endocarditis in the context of pulmonary adenocarcinoma: a case report
title_sort non-bacterial thrombotic endocarditis in the context of pulmonary adenocarcinoma: a case report
topic Case Reports
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7047059/
https://www.ncbi.nlm.nih.gov/pubmed/32128491
http://dx.doi.org/10.1093/ehjcr/ytaa008
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