Department of General Internal Medicine, Hashimoto Municipal Hospital, Hashimoto 648-0005, Japan.
Hinata Medical Clinic, Osaka 543-0062, Japan.
Medicina (Kaunas). 2021 Nov 18;57(11):1264. doi: 10.3390/medicina57111264.
Valve vegetation is one of the most fearful findings for physicians. The first diagnosis that comes to their mind is infective endocarditis (IE), but it can also be noninfective; nonbacterial thrombotic endocarditis (NBTE). NBTE can be even more challenging than IE for physicians because of the wide range of differential diagnoses such as malignancies, autoimmune disorders and human immunodeficiency virus. A 45-year-old woman presented at the emergency room with a sudden onset of dysarthria and right-sided hemiplegia. Laboratory data showed her blood counts and coagulation test were mostly normal and the magnetic resonance imaging detected a high-signal-intensity change in her left brain. An echocardiogram found a vegetation-like structure on her atrial valve. We highly suspected IE leading to cerebral embolism. The clot was successfully removed by our neurosurgeons and anticoagulation therapy was started concurrently. Her state of consciousness improved, but then she suffered a brain hemorrhage and died. The autopsy revealed that the cause of her vegetation was acute promyelocytic leukemia (APL). Based on these findings, it is important to remember that APL can be the cause of NBTE even if the blood count and coagulation tests are almost normal.
心瓣膜赘生物是医生最担心的发现之一。他们首先想到的诊断是感染性心内膜炎（IE），但它也可能是非感染性的；非细菌性血栓性心内膜炎（NBTE）。由于恶性肿瘤、自身免疫性疾病和人类免疫缺陷病毒等广泛的鉴别诊断，NBTE 比 IE 对医生更具挑战性。一名 45 岁女性因突发构音障碍和右侧偏瘫到急诊室就诊。实验室数据显示，她的血常规和凝血试验基本正常，磁共振成像显示她的左脑有高信号强度变化。超声心动图发现她的心房瓣膜上有一个类似赘生物的结构。我们高度怀疑是 IE 导致脑栓塞。我们的神经外科医生成功地将血栓取出，并同时开始抗凝治疗。她的意识状态有所改善，但随后她又发生脑出血并死亡。尸检显示，她的赘生物是急性早幼粒细胞白血病（APL）引起的。根据这些发现，重要的是要记住，即使血常规和凝血试验基本正常，APL 也可能是 NBTE 的原因。
