Ovarian Clear Cell Carcinoma Presenting as Non-bacterial Thrombotic Endocarditis and Systemic Embolization

Non-bacterial thrombotic endocarditis (NBTE) is a rare manifestation of cancer-induced hypercoaguability. It most commonly occurs in association with mucin-producing adenocarcinomas and has rarely been described with ovarian clear cell carcinoma (OCCC). We report a case of NBTE with multi-organ embolic infarcts occurring in a patient with early stage clear cell ovarian cancer. A 56 years old Caucasian female presented with leg pain, and left flank discomfort. Evaluation revealed multi-organ infarction, extensive deep vein thrombosis (DVT), and the incidental presence of an asymptomatic large ovarian mass with a laboratory picture consistent with disseminated intravascular coagulation (DIC). The diagnosis of NBTE was supported by echocardiogram and multiple negative bacteriological studies. She underwent surgical extirpation of an early stage OCCC and initiation of anticoagulation. Postoperatively, the patient's hypercoaguability promptly resolved with gradual resolution of vegetations. Subsequent recurrence of the malignancy was heralded by a return of the prothrombotic state. This case shows a rarely reported association between NBTE and OCCC. It illustrates how the clinical picture of NBTE can dominate the initial presentation of an early stage and otherwise asymptomatic malignancy. Late recognition can lead to significant morbidity and a rapidly fatal course. Recurrent thromboembolism may be the first indication of disease recurrence.