Kaufmann Christoph C, Wessely Emil, Huber Kurt
3rd Medical Department of Cardiology and Intensive Care Medicine, Wilhelminenhospital, Montleartstrasse 37, A-1160 Vienna, Austria.
Medical Faculty, Sigmund Freud University, Vienna, Austria.
Eur Heart J Case Rep. 2020 Feb 10;4(1):1-5. doi: 10.1093/ehjcr/ytaa008. eCollection 2020 Feb.
Non-bacterial thrombotic endocarditis (NBTE) is a rare condition, usually observed in association with malignancy, lupus erythematosus, or antiphospholipid syndrome. Diagnosis of NBTE remains a challenge as patients are often asymptomatic up to their first thromboembolic event. While there is no randomized data available for the guidance of treatment in NBTE, effective anticoagulation remains the main focus in the management of affected patients.
A 44-year-old female patient without a significant medical history presented to the emergency department with a new numbness of her right hand. Magnetic resonance imaging scans facilitated the diagnosis of supratentorial stroke. Within the next 3 months, the patient had multiple thromboembolic events, including multiple strokes, pulmonary embolism, and renal/splenic infarction. Echocardiographic examination revealed large, transient vegetations of the aortic valve with concomitant aortic regurgitation. In addition, an incidental, pulmonary non-small-cell adenocarcinoma was found during the diagnostic work-up. Infective endocarditis was excluded by several negative blood cultures and missing signs of infection. Hence, the diagnosis of NBTE secondary to malignancy was made.
We present a rare case of NBTE in the context of pulmonary adenocarcinoma. The adequate treatment of malignancy and effective anticoagulation are the main treatment options.
非细菌性血栓性心内膜炎（NBTE）是一种罕见疾病，通常与恶性肿瘤、红斑狼疮或抗磷脂综合征相关。由于患者在首次发生血栓栓塞事件之前通常无症状，因此NBTE的诊断仍然是一项挑战。虽然目前尚无随机数据可用于指导NBTE的治疗，但有效的抗凝治疗仍然是管理受影响患者的主要重点。
一名44岁无重大病史的女性患者因右手新发麻木就诊于急诊科。磁共振成像扫描有助于诊断幕上卒中。在接下来的3个月内，该患者发生了多次血栓栓塞事件，包括多次卒中、肺栓塞以及肾/脾梗死。超声心动图检查显示主动脉瓣有大的、短暂的赘生物，并伴有主动脉瓣反流。此外，在诊断检查过程中偶然发现了肺部非小细胞腺癌。多次血培养阴性且无感染迹象，排除了感染性心内膜炎。因此，诊断为继发于恶性肿瘤的NBTE。
我们报告了一例在肺腺癌背景下发生的罕见NBTE病例。对恶性肿瘤进行适当治疗和有效的抗凝治疗是主要的治疗选择。
