Elikowski Waldemar, Jarząbek Radosław, Małek Małgorzata, Witczak Włodzimierz, Łazowski Stanisław, Psuja Piotr
Józef Struś Hospital, Poznań, Poland: Department of Internal Medicine.
Józef Struś Hospital, Poznań, Poland: Department of Cardiac Surgery.
Pol Merkur Lekarski. 2016 Mar;40(237):182-5.
Non-bacterial thrombotic endocarditis (NBTE) is characterized by presence of sterile vegetations that develop from fibrin and platelets on heart valves. The main conditions predisposing to NBTE are malignancy, autoimmune diseases and other hypercoagulable states. The authors describe a case of a 25-year-old male, in whom NBTE was diagnosed on the bicuspid aortic valve. The presence of significant aortic regurgitation and dental caries were initially suggestive of infective endocarditis; although, serial blood culture were negative and procalcytonin concentration was within normal ranges. Empiric antibiotic therapy did not result in diminishing of vegetations, similarly to the anticoagulation treatment initiated when strongly positive lupus anticoagulant was detected in laboratory findings. Aortic valve replacement was necessary. Bacteriologic examination of the excised valve was negative. Widespread fibrin masses at different stages of organization on the leaflets confirmed NBTE in histopathologic assessment. Lupus anticoagulant was probably secondary to thyroid autoimmune disease.
非细菌性血栓性心内膜炎（NBTE）的特征是在心脏瓣膜上由纤维蛋白和血小板形成无菌性赘生物。导致NBTE的主要因素是恶性肿瘤、自身免疫性疾病和其他高凝状态。作者描述了一例25岁男性病例，其在二尖瓣主动脉瓣上被诊断为NBTE。显著的主动脉瓣反流和龋齿最初提示感染性心内膜炎；然而，系列血培养结果为阴性，降钙素原浓度在正常范围内。经验性抗生素治疗并未使赘生物缩小，与实验室检查发现狼疮抗凝物强阳性时开始的抗凝治疗效果相同。主动脉瓣置换术是必要的。切除瓣膜的细菌学检查为阴性。组织病理学评估显示，瓣叶上不同组织阶段的广泛纤维蛋白团块证实为NBTE。狼疮抗凝物可能继发于甲状腺自身免疫性疾病。
