Recurrent Cancer-Associated Nonbacterial Endocarditis Presenting With Systemic Embolic Complications

Nonbacterial thrombotic endocarditis (NBTE) is a rare complication of malignancy, often leading to systemic embolization.

A 52-year-old woman presented with embolic ischemic stroke, multiple systemic infarctions, a pelvic mass, and aortic valve vegetations. The pelvic mass was completely resected and was subsequently diagnosed as ovarian clear cell carcinoma. The valvular vegetations were identified as NBTE. Despite ongoing anticoagulation therapy with edoxaban, she developed recurrent vegetations on the mitral valves in association with cancer recurrence. Based on the patient's preference, anticoagulation therapy with edoxaban was continued. She later experienced an upper limb arterial embolism and died after 3 months.

This case highlights the diagnostic and therapeutic challenges of NBTE in cancer patients, particularly in the context of temporally distinct recurrences involving different cardiac valves despite appropriate oncologic and anticoagulant therapy.

Vigilant valvular monitoring and individualized anticoagulation strategies are necessary when managing patients with hypercoagulable malignancies.