[Identification of an adenocarcinoma in the context of non-infectious paraneoplastic endocarditis]

Non infectious thrombotic endocarditis represent 2.5 % of negative blood culture endocarditis cases. These conditions are most often diagnosed post-mortem, but can be revealed following a complication. Among the most common causes are cancers, specifically pancreatic, pulmonary, colon and prostate adenocarcinomas. We present the case of a 59-year old woman with a diagnosis of endocarditis during an etiological assessment of stroke. She underwent aortic valve replacement due to a major embolic risk. During this etiological assessment, a hypermetabolic site was found in the pancreas on PET-scan, which turned out to be a pancreatic adenocarcinoma. Paraneoplastic non-infectious endocarditis complicates 19 % of cancers and has a poor prognosis due to late diagnosis, often revealing advanced cancer. Treatment relies on low molecular weight heparin anticoagulation, combined with treatment of the underlying cancer. We present an updated review of the literature and most recent data accounting for the formation of valve thrombus.