Embolic Stroke in a Patient with Marantic Endocarditis: A Case Report
Keywords:
Non-bacterial thrombotic endocarditis, marantic endocarditis, embolic stroke, lung adenocarcinomaAbstract
Non-bacterial thrombotic endocarditis (NBTE) is an unusual valvular heart disease which may occur in patients with underlying malignancies or systemic autoimmune diseases. “Marantic endocarditis” is named specifically for the cardiac vegetation pertaining to malignancies. It can cause embolus propagation to distal organs, occluding blood vessels that nourish these organs. Symptoms can vary based on the affected ischemic sites; for instance, focal neurological deficits as a consequence of cerebral vessel occlusion.
Herein, we described a 64-year-old woman with an advanced stage of adenocarcinoma of the lung presenting with two episodes of left hemiparesis within a week. Brain MRI showed restricted diffusion in multiple vascular territories of the brain, along with severe stenosis of the M2 segment of the right middle cerebral artery. Transesophageal echocardiography revealed vegetations on the mitral and tricuspid leaflets. A series of blood cultures showed no organism. Thrombophilic test indicated a dramatic increase in D-dimer level. She was diagnosed with embolic stroke related to marantic endocarditis and treated with parenteral anticoagulants. She was discharged from the hospital with modified Rankin Scale of 4. The prognosis of NBTE with distal embolism depends on the malignancy stage and the severity of the embolic strokes.
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