A rare presentation of nonbacterial thrombotic endocarditis

Nonbacterial thrombotic endocarditis is a rare disease in which a hypercoagulable condition-usually malignancy or an autoimmune state-precipitates the formation of sterile vegetations on cardiac valves. Mortality is high due to cerebral embolization, cardiac failure, and progression of the underlying disease process. Lower-limb ischemia is uncommon, and reported upper-limb and hepatic ischemia are rare. Both transthoracic and transesophageal echocardiography are the diagnostic modalities of choice for confirming valvular vegetations. We report a patient who presented with multiple unusual embolization sites; with multidisciplinary assistance, she was diagnosed and treated for nonbacterial thrombotic endocarditis.