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Medical Science Monitor Basic Research


Marantic endocarditis with cerebral embolism as the presenting symptom of adenocarcinoma of the lung

Sorel Goland, Adrian Duek, Stephen Malnick, Daniel Rappaport, Marina Assayev, Marina Somin, Malka Attali

CaseRepClinPractRev 2004; 5:388-391

ID: 12336

Available online: 2004-04-20

Published: 2004-04-20

Background: Non-bacterial thrombotic endocarditis (NBTE) is a relatively uncommon condition that is usually diagnosed on post-mortem. The main associations are malignancy and autoimmune disease.Case Report: We present a case of a 64-year-old man, with good performance status, who suffered from 2 cerebral events of an embolic nature within a short period of time. Transesophageal, but not transthoracic echocardiography showed a vegetation on the aortic valve. There was no evidence for an infective etiology. CT scan of the chest (following the finding of a suspected right upper lobe infiltrate in the lung) demonstrated a 3 cm mass in the right lung with enlargementof paratracheal lymph nodes and in addition pleural fluid on the right. Paracentesis of the pleural fluid revealed malignant cells. Subsequently, the patient developed a left parietal hemorrhage and died.Conclusions: This is a rare case of ante-mortem diagnosis of NTBE. The possibility of an underlying malignancy should be considered in patients with embolic stroke of unknown origin.

Keywords: Non-bacterial thrombotic endocarditis, cerebral infarction, lung carcinoma