Recuero-Borau Jordi, Masfarré Laura, Navarro Nil, Rocha Pedro, Taus Álvaro, Arriola Edurne
Department of Medical Oncology, Hospital del Mar, Barcelona, Spain.
Transl Lung Cancer Res. 2024 Jan 31;13(1):179-185. doi: 10.21037/tlcr-23-412. Epub 2024 Jan 22.
Lung cancer is one of the tumor types with highest incidence of thromboembolic events (TE), especially adenocarcinoma subtype. rearrangements confer higher risk of TE. Non-bacterial thrombotic endocarditis (NBTE) is a rare event, frequently diagnosed on autopsy. Clinical suspicion is key to reach the diagnosis and start early treatment of the underlying cause and anticoagulation in order to improve patients' outcomes.
Here we present two cases of NBTE in patients with -rearranged lung cancer with different clinical debuts. A 42-year-old woman presented initial tetraplegia and impaired level of consciousness, and the other patient, a 54-year-old man, was diagnosed of stroke with sensitive loss of left body. Both were diagnosed of NBTE, confirmed by the finding of cardiac vegetation on echocardiogram and no microorganisms found on blood cultures. Both responded well to targeted therapy with lorlatinib and crizotinib and anticoagulation with heparin.
NBTE is an infrequent disease which can cause severe neurological symptoms that impair quality of life, performance status and survival. Early clinical suspicion in patients with higher risk of TEs such as patients with rearrangements of gene is of essence. Adequate management of underlying disease and anticoagulation may impact in the recovery of symptoms.
肺癌是血栓栓塞事件（TE）发生率最高的肿瘤类型之一，尤其是腺癌亚型。基因重排会增加TE的风险。非细菌性血栓性心内膜炎（NBTE）是一种罕见事件，常在尸检时被诊断出来。临床怀疑是做出诊断以及开始对潜在病因进行早期治疗和抗凝以改善患者预后的关键。
在此，我们呈现两例基因重排型肺癌患者发生NBTE的病例，其临床表现各异。一名42岁女性最初出现四肢瘫痪和意识水平受损，另一名患者是一名54岁男性，被诊断为中风并伴有左侧身体感觉丧失。两人均被诊断为NBTE，经超声心动图发现心脏赘生物且血培养未发现微生物得以证实。两人对洛拉替尼和克唑替尼靶向治疗以及肝素抗凝治疗反应良好。
NBTE是一种罕见疾病，可导致严重的神经症状，损害生活质量、身体状况和生存率。对于TE风险较高的患者，如基因重排患者，早期临床怀疑至关重要。对基础疾病进行充分管理和抗凝可能会影响症状的恢复。
