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

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