非细菌性血栓性心内膜炎及肺腺癌引发的栓子播散
Embolic Showering from Non-Bacterial Thrombotic Endocarditis and Adenocarcinoma of the Lung.
作者信息
Cheung Brian, Shivkumar Abhijit, Ahmed Ahmed S
机构信息
Saint Bernards Healthcare, Jonesboro, Arkansas, USA.
出版信息
Eur J Case Rep Intern Med. 2020 Jul 20;7(10):001798. doi: 10.12890/2020_001798. eCollection 2020.
BACKGROUND
Non-bacterial thrombotic endocarditis (NBTE) is a paraneoplastic phenomenon with sterile vegetations. It is associated with adenocarcinoma and can shower emboli, which can be the presenting symptom.
CASE PRESENTATION
A 44-year-old woman with adenocarcinoma of the lung presented with chest pain, left hand weakness, and ataxia due to repeated embolic showering from NBTE to the central nervous system (CNS) and spleen.
CONCLUSION
NBTE is a rare condition that should be on the differential diagnosis in patients with culture-negative endocarditis and a history of adenocarcinoma.
LEARNING POINTS
Differentiating non-bacterial thrombotic endocarditis (NBTE) from infective endocarditis can be a diagnostic challenge due to slow growing organisms; laboratory findings that suggest NBTE include the lack of leucocytosis, normal C-reactive protein, negative blood culture sets, and positive antiphospholipid antibodies.Serial transesophageal echocardiogram (TEE) should be performed if suspicion of valvular vegetations is high despite the initial TEE showing no vegetations.The mainstay treatment of NBTE is anticoagulation and addressing the underlying condition.
背景
非细菌性血栓性心内膜炎（NBTE）是一种伴有无菌性赘生物的副肿瘤现象。它与腺癌相关，可形成栓子，栓子脱落可能是首发症状。
病例介绍
一名44岁的肺癌腺癌女性患者，因NBTE反复向中枢神经系统（CNS）和脾脏形成栓子脱落，出现胸痛、左手无力和共济失调。
结论
NBTE是一种罕见疾病，对于血培养阴性的心内膜炎且有腺癌病史的患者应列入鉴别诊断。
学习要点
由于病原体生长缓慢，将非细菌性血栓性心内膜炎（NBTE）与感染性心内膜炎区分开来可能是一项诊断挑战；提示NBTE的实验室检查结果包括无白细胞增多、C反应蛋白正常、血培养结果阴性以及抗磷脂抗体阳性。如果尽管初始经食管超声心动图（TEE）未显示赘生物，但高度怀疑有瓣膜赘生物，应进行系列经食管超声心动图检查。NBTE的主要治疗方法是抗凝及治疗潜在疾病。
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