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Nonbacterial thrombotic endocarditis presenting as aortic stenosis with suspected infective endocarditis:

Mohammed Kurdi1, Donald S Beanlands, Kwan L Chan

  • 1Department of Medicine, University of Ottawa, Ottawa, Canada.

The Canadian Journal of Cardiology
|April 22, 2004
PubMed

Insights

Non-bacterial thrombotic endocarditis (NBTE) can mimic sepsis and infective endocarditis, especially when associated with malignancy. This case highlights the diagnostic challenges and fatal outcomes of NBTE in a patient with metastatic adenocarcinoma.

Area of Science:

  • Cardiology
  • Oncology
  • Pathology

Background:

  • Endocarditis is traditionally classified into infective and non-bacterial thrombotic endocarditis (NBTE).
  • NBTE is often linked to connective tissue diseases, chronic inflammation, and malignancy.
  • Historically, NBTE diagnosis relied heavily on postmortem examination before the advent of echocardiography.

Observation:

  • A 63-year-old female presented with transient cerebral ischemic attacks and weight loss, later developing aortic stenosis.
  • She was initially treated for infective endocarditis but developed sepsis and disseminated intravascular coagulation.
  • Despite aortic valve replacement, the patient experienced early postoperative mortality.

Findings:

  • Autopsy revealed valvular NBTE, multiple vascular thromboses, and metastatic adenocarcinoma of an unknown primary site.
  • The findings underscore the association between NBTE and malignancy.
  • NBTE associated with cancer can present clinically similar to sepsis and infective endocarditis.

Implications:

  • This case emphasizes the importance of considering NBTE in patients with unexplained sepsis, particularly when malignancy is suspected.
  • Early recognition and diagnosis of NBTE associated with cancer are crucial for potentially improving patient outcomes.
  • Further research into the mechanisms and diagnostic markers for malignancy-associated NBTE is warranted.

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