Systemic thromboembolism from a misdiagnosed non‑bacterial thrombotic endocarditis in a patient with lung cancer: A case report

Perrone, Fabiana; Biagi, Andrea; Facchinetti, Francesco; Bozzetti, Francesca; Ramelli, Andrea; Vezzani, Antonella; Manca, Tullio; Gnetti, Letizia; Majori, Maria; Alfieri, Veronica; Tiseo, Marcello

doi:10.3892/ol.2020.12056

Cited by 7 publications

(5 citation statements)

References 32 publications

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“…Two additional cases reported echocardiogram findings suggestive of infective endocarditis; one such case diagnosed NBTE of the mitral valve in a patient with known stage 4 malignancy [ 12 ]. Another case presented initially with acute deep venous thrombosis and pulmonary embolism with an incidentally identified lung mass; subsequently, this patient developed additional thrombotic events eventually leading to the diagnosis of NBTE of the mitral valve in the setting of large cell carcinoma [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

An Unusual Case of Mucinous Adenocarcinoma of the Lung Presenting as Septic Emboli

DEMARS¹,

Khan²,

LeBel³

et al. 2023

Cureus

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This is a case of a 92-year-old female with multiple hospitalizations for dyspnea on exertion and hypoxemia. Her symptoms were initially thought to be secondary to pneumonia, and on subsequent admission, culture-negative endocarditis. A computed tomography (CT) of the chest was remarkable for numerous bilateral lung nodules of varying size, some of which had a cavitary appearance raising concern for septic emboli. While a transthoracic echo was unremarkable, a transesophageal echo found a small 3 mm echodensity at the tip of the right coronary leaflet of the aortic valve and a possible mobile echodensity on the tricuspid valve leaflet. These findings further supported a clinical diagnosis of endocarditis with septic emboli in the lungs. Initial bronchoscopy yielded an unremarkable biopsy and a bronchial alveolar lavage with the growth of Actinomyces odontolyticus . During a subsequent hospitalization, a repeat bronchoscopy with transbronchial biopsy revealed a final diagnosis of invasive pulmonary mucinous adenocarcinoma. This case highlights a unique presentation of mucinous adenocarcinoma of the lung initially masquerading as septic emboli, resulting in a delay in the final diagnosis.

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Section: Discussionmentioning

confidence: 99%

An Unusual Case of Mucinous Adenocarcinoma of the Lung Presenting as Septic Emboli

DEMARS¹,

Khan²,

LeBel³

et al. 2023

Cureus

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“…[20] Although the prognosis of cases diagnosed in recent years is more favorable in terms of survival, [20] numerous reports document instances of patient death before the initiation of cancer treatment. [21][22][23][24] A systematic review of 163 cases with newly diagnosed NBTE identified an in-hospital mortality rate of 30%. It further demonstrated that factors such as splenic infarction, renal infarction, pulmonary embolism, and mitral valve regurgitation (all present in the patient in our case) were among the factors associated with an increased risk of in-hospital mortality.…”

Section: Demonstrationmentioning

confidence: 99%

Non-bacterial thrombotic endocarditis: a case report with favorable evolution and literature review

Henn¹,

Martins²,

Gatelli³

2023

Brazilian Journal of Oncology

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Nonbacterial thrombotic endocarditis is an uncommon disease characterized by formation and deposition of sterile fibrin vegetations on heart valves. This condition is more related to states of chronic inflammation, mainly related to malignancy. This report describes the case of a Brazilian woman, 50 years old, smoker, diagnosed with pulmonary adenocarcinoma with pleural and bone metastases after presenting with deep venous thrombosis and pulmonary embolism. During the investigation, a transthoracic echocardiogram was performed, which revealed a mobile echogenic mass in the mitral leaflet. As there were no suggestive signs or laboratory tests that corroborated a systemic bacterial infection, the diagnosis of non-bacterial thrombotic endocarditis was confirmed. Given the poor prognosis related to the disease, suspicion and early treatment were determining factors for the favorable evolution presented.

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“…As is true with most neoplasms, lung cancer can have a variety of adverse effects on the body, including hypercoagulability, which can lead to thromboembolic events such as pulmonary emboli (PE), deep vein thrombosis (DVT), ischemic strokes, and non-bacterial thrombotic endocarditis (NBTE) [1][2][3]. Hypercoagulability due to cancer is, in part, due to an imbalance between factors that drive coagulation and fibrinolysis [4]. Cancer cells can release procoagulant factors such as tissue factor and thrombin, and there is often inflammation leading to the recruitment of proinflammatory cytokines such as tumor necrosis factorα (TNF-α) and interleukin-1 (IL-1) [4,5].…”

Section: Introductionmentioning

confidence: 99%

“…Hypercoagulability due to cancer is, in part, due to an imbalance between factors that drive coagulation and fibrinolysis [4]. Cancer cells can release procoagulant factors such as tissue factor and thrombin, and there is often inflammation leading to the recruitment of proinflammatory cytokines such as tumor necrosis factorα (TNF-α) and interleukin-1 (IL-1) [4,5]. The production of these factors leads to a hypercoagulable state which promotes coagulation and thrombi formation [2].…”

Section: Introductionmentioning

confidence: 99%

Recurrent Thromboembolic Events While on Anticoagulation Lead to the Diagnosis of Metastatic Lung Adenocarcinoma: A Case Report

Brubaker¹,

Sooklal²

2023

Cureus

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Lung cancer can lead to hypercoagulability that causes thromboembolic events such as pulmonary emboli, deep vein thrombosis, ischemic strokes, and non-bacterial thrombotic endocarditis. While it is not uncommon for cancer to cause thromboembolic events, it is unusual for thrombotic events to be the first manifestation of cancer. In the following report, we review the case of a 59-year-old woman who presented with melena and abdominal pain. She had a pertinent history of multiple thromboembolisms while on anticoagulation four months before this presentation. Upon admission, it was discovered that the patient had new pulmonary emboli, and further workup revealed that her gastrointestinal symptoms were due to ischemic colitis. While initial imaging showed no evident masses that would heighten suspicion of cancer, she had persistent abdominal lymphadenopathy. Therefore, she also underwent an abdominal lymph node biopsy which revealed metastatic lung adenocarcinoma, a possible cause of her hypercoagulable state. This case report highlights the importance of considering malignancy in the differential of a patient with recurrent thromboembolism and raises the question of whether standardized screening for malignancy in patients with multiple thromboembolic events would be beneficial.

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Systemic thromboembolism from a misdiagnosed non‑bacterial thrombotic endocarditis in a patient with lung cancer: A case report

Cited by 7 publications

References 32 publications

An Unusual Case of Mucinous Adenocarcinoma of the Lung Presenting as Septic Emboli

An Unusual Case of Mucinous Adenocarcinoma of the Lung Presenting as Septic Emboli

Non-bacterial thrombotic endocarditis: a case report with favorable evolution and literature review

Recurrent Thromboembolic Events While on Anticoagulation Lead to the Diagnosis of Metastatic Lung Adenocarcinoma: A Case Report

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