Research Day
LIBMAN-SACKS ENDOCARDITIS AS THE INITIAL PRESENTATION OF METASTATIC ADENOCARCINOMA
Document Type
Abstract
Date
2021
Abstract
Introduction: Nonbacterial thrombotic endocarditis (NBTE), "marantic", or "Libman-Sacks" endocarditis is a rare entity describing endocarditis that is non-infectious and usually secondary to advanced malignancy or systemic lupus erythematosus (SLE). NBTE usually is found on autopsy, however some patients are diagnosed antemortem. The most common malignancy associated with NBTE is adenocarcinoma including lung, colon, ovary, biliary, prostate, and pancreatic.
Case: 63-year-old female with past medical history of recently diagnosed pulmonary embolism and multivessel DVT's on Eliquis presented with SOB and chest tightness. She was found to have bilateral pleural effusions, thrombocytopenia, and splenic infarcts. Echocardiogram showed severe mitral regurgitation with two large mitral valve vegetations suggestive of Libman-Sacks endocarditis. Four sets of blood cultures had no growth during the hospitalization, and other atypical causes of infectious endocarditis were ruled out. Rheumatological work-up was nonrevealing including SLE and anti-phospholipid antibody syndrome. Thoracentesis of right and left pleural effusions demonstrated metastatic adenocarcinoma, likely secondary to an upper gastrointestinal source.
Discussion: NBTE is characterized by endothelial injury leading to the deposition of thrombi on heart valves. It is a separate entity from culture-negative endocarditis and infectious causes, including atypical organisms, must be ruled out to diagnose NBTE. NBTE can present as an atypical manifestation of malignancy and must be differentiated from infective endocarditis. When presented with endocarditis without a clear etiology, advanced malignancy must be ruled out. Treatment of NBTE secondary to neoplasm consists of systemic anticoagulation as well as treatment directed against the underlying malignancy.