Non-Bacterial Thrombotic Endocarditis Presenting With Bullae And Blindness
Non-bacterial thrombotic endocarditis (NBTE), also known as marantic endocarditis, is a potential complication that can arise in association with cancer. Presented here is a case of marantic endocarditis in the setting of metastatic adenocarcinoma. A 78 year old male with a history of cerebrovascular accident, paroxysmal atrial fibrillation on rivaroxaban, bioprosthetic aortic valve, and recent laparoscopic cholecystectomy, presented with acute transient visual loss of the right eye that lasted for ten minutes and abdominal pain. Imaging was negative for any acute findings. Physical exam was significant for multiple large intact and ruptured bullae and ecchymotic lesions on bilateral feet. One week prior to presentation, patient had presented again with abdominal pain and computed tomography of the abdomen was performed showing multiple hypodense hepatic lesions, the largest being 5.7x3.4cm. Transesophageal echocardiogram displayed a 1.5x1.8cm mobile mass attached to the prosthetic aortic valve. Multiple blood cultures were negative for growth. Biopsy of the liver lesions ultimately revealed metastatic gastrointestinal adenocarcinoma. Patient was subsequently diagnosed with NBTE. With patient's newly diagnosed metastatic cancer and multiple comorbidities, patient was discharged home with home hospice management. Non-bacterial endocarditis should always be suspected in patients with negative blood cultures, as it can cause further complication to an already complex case and requires systemic anticoagulation and/or surgery if aggressive treatment is desired.