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• W4387248850 abstract "SESSION TITLE: Lung Cancer Case Report Posters 12 SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 02:10 pm - 02:55 pm INTRODUCTION: Nonbacterial Thrombotic Endocarditis (NBTE) known complication of the hypercoagulable state associated with advanced malignancy. Our case highlights the importance of having a high clinical suspicion of NBTE mimicking as endocarditis presenting with congestive heart failure, severe aortic regurgitation along with systemic embolization even in the absence of bacteremia. CASE PRESENTATION: 69-year-old female patient presented to the hospital as a direct admission from the hematologist's office due to significant thrombocytopenia on therapeutic anticoagulation. Three months before admission, she was treated for a right lower lobe pneumonia and a right internal jugular thrombosis. Pertinent signs and symptoms included a persistent cough with hemoptysis and diminished breath sounds on lung examination. Laboratory findings confirmed thrombocytopenia (45 k/uL), elevated D-dimer with decreased fibrinogen, and abnormal coagulation studies suggestive of DIC. Chest imaging revealed a right lower and middle lobe pneumonia with a small pleural effusion, associated with mediastinal and axillary lymphadenopathy (Figure 1). CT scan of the abdomen and pelvis showed an incidental SMA embolism causing partial occlusion. Despite nonrevealing transthoracic echocardiogram and negative blood cultures, transesophageal echocardiogram (TEE) was performed due to concern of endocarditis which revealed 0.9 cm, mobile filamentous mass with severe aortic regurgitation (Figure 2). Patient underwent successful aortic valve replacement. Her thrombocytopenia resolved within two days. Pathology and cytology reports of aortic valve suggested adenocarcinoma of the lung and findings consistent with NBTE. Subsequently she was transferred to cardiac rehab and is undergoing chemotherapy for lung cancer. DISCUSSION: NBTE can be challenging to distinguish between subacute infectious endocarditis, since complications of recurrent emboli, heart failure, and valvular dysfunction can occur with these entities. Negative blood cultures can help distinguish between these two, especially with the association with disseminated intravascular coagulation. High clinical suspicion of NBTE in patients with recurrent thrombosis regardless of negative blood cultures has seen in our case. CONCLUSIONS: Diagnosis of NBTE should be suspected in patient with findings suggestive of DIC and recurrent thrombosis, despite DOACs treatment for VTE. If NBTE is confirmed, then evaluation of malignancy must be considered. REFERENCE #1: Khaled el-Shami, Elizabeth Griffiths, Michael Streiff, Nonbacterial Thrombotic Endocarditis in Cancer Patients: Pathogenesis, Diagnosis, and Treatment, The Oncologist, Volume 12, Issue 5, May 2007, Pages 518–523, https://doi.org/10.1634/theoncologist.12-5-518 REFERENCE #2: Shahad Al Chalaby, Rakhee R Makhija, Ajay N. Sharma, Muhammad Majid, Edris Aman, Sandhya Venugopal, Ezra A. Amsterdam. Nonbacterial Thrombotic Endocarditis: Presentation, Pathophysiology, Diagnosis and Management. Rev. Cardiovasc. Med. 2022, 23(4), 137. https://doi.org/10.31083/j.rcm2304137 REFERENCE #3: Athanazio RA, Ceresetto JM, Marfil Rivera LJ, Cesarman-Maus G, Galvez K, Marques MA, Tabares AH, Ortiz Santacruz CA, Santini FC, Corrales L, Cohen AT. Direct Oral Anticoagulants for the Treatment of Cancer-Associated Venous Thromboembolism: A Latin American Perspective. Clin Appl Thromb Hemost. 2022 Jan-Dec;28:10760296221082988. doi: 10.1177/10760296221082988. PMID: 35261295; PMCID: PMC8918974. DISCLOSURES: No disclosure on file for Sushama Jasti No relevant relationships by Stephanie Paduano No relevant relationships by Sridevi Pitta" @default.
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• W4387248850 date "2023-10-01" @default.
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• W4387248850 title "DISGUISING THE TRUTH: MARANTIC ENDOCARDITIS SECONDARY TO LUNG ADENOCARCINOMA" @default.
• W4387248850 doi "https://doi.org/10.1016/j.chest.2023.07.2843" @default.
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