非细菌性血栓性心内膜炎(NBTE)涉及纤维蛋白和血小板在心脏瓣膜上的沉积,经常导致全身性栓塞。NBTE与癌症之间的关联需要在缺乏明显原因的情况下进行彻底调查。此病例报告阐明了一名60多岁的非吸烟妇女的临床过程,NBTE与肺腺癌有关。病人,有多发性硬化症(MS)病史,正在接受富马酸二甲酯治疗,出现类似中风症状的急诊科。由于MS预先存在的运动感觉障碍,出现了诊断挑战。初步评估显示低碳酸血症和炎症标志物升高。获得两次血培养物,影像学证实肺炎,左侧胸腔积液,和慢性肺栓塞,同时排除急性血管事件或颅内出血。首次经胸超声心动图(TTE)显示无心脏异常。治疗包括肠胃外抗生素,全身抗凝,进入医疗楼层。尽管最初的治疗产生了积极的临床反应,随后出现并发症。第十天,患者需要额外的干预,包括广谱抗生素和补充氧气.胸部X线随访显示持续性肺炎和胸腔积液,入院时的血培养结果为阴性。随后的头部MRI证实了栓塞性中风,并显示了MS进展的证据。大约在第20天,开始对感染性心内膜炎进行经验性治疗,通过经食管超声心动图(TOE)确定主动脉瓣上8毫米的植被。急性肺水肿促使转移到中间护理单元。进一步调查,包括左侧胸腔穿刺术和CT,揭示了肝脏中的渗出物和转移性病变,髂骨,还有肾.不幸的是,在第25天,患者经历了急性心肌梗死,右腿缺血,弥散性血管内凝血,和震惊。胸水分析显示恶性细胞提示肺腺癌。此病例强调了当感染性心内膜炎和自身免疫性小组的检查结果为阴性时,及时识别NBTE和寻找恶性肿瘤的关键作用。此外,它强调了警惕监测的重要性,特别是在免疫功能低下的个体或先前存在神经功能缺损的个体中,尤其是当出现新的神经症状时.这些见解大大有助于理解NBTE管理及其对类似患者队列的影响。
Non-bacterial thrombotic endocarditis (NBTE) involves the deposition of fibrin and platelets on heart valves, frequently leading to systemic embolism. The association between NBTE and cancer demands thorough investigation in cases lacking an evident cause. This case report elucidates the clinical course of a nonsmoking woman in her sixties with NBTE linked to pulmonary adenocarcinoma. The patient, who had a history of multiple sclerosis (MS) and was receiving dimethyl fumarate treatment, presented to the emergency department with stroke-like symptoms. Diagnostic challenges arose due to preexisting motor sensory impairment from MS. Initial evaluations revealed hypocapnia and elevated inflammatory markers. Blood cultures were obtained twice, and imaging confirmed pneumonia, left pleural effusion, and chronic pulmonary embolism while excluding acute vascular events or intracranial hemorrhage. The first transthoracic echocardiogram (TTE) indicated no cardiac abnormalities. Treatment encompassed parenteral antibiotics, systemic anticoagulation, and admission to medical floors. Although the initial treatment yielded a positive clinical response, subsequent complications emerged. On the tenth day, the patient required additional interventions, including broad-spectrum antibiotics and supplemental oxygen. A follow-up chest X-ray revealed persistent pneumonia and pleural effusion, and blood cultures upon admission returned negative. A subsequent head MRI confirmed an embolic stroke and displayed evidence of MS progression. Around the twentieth day, empirical treatment for infective endocarditis was initiated, and an 8 mm vegetation on the aortic valve was identified via transesophageal echocardiography (TOE). Acute pulmonary edema prompted a transfer to the intermediate care unit. Further investigations, including left thoracocentesis and CT, unveiled exudate and metastatic lesions in the liver, ilium, and kidney. Unfortunately, on the twenty-fifth day, the patient experienced acute myocardial infarction, right leg ischemia, disseminated intravascular coagulation, and shock. Pleural fluid analysis revealed malignant cells suggestive of lung adenocarcinoma. This case underscores the pivotal role of timely NBTE recognition and the search for malignancy when workup for infective endocarditis and autoimmune panels is negative. Moreover, it emphasizes the significance of vigilant monitoring, particularly in immunocompromised individuals or those with preexisting neurological deficits, especially when new neurological symptoms manifest. These insights significantly contribute to the comprehension of NBTE management and its implications for analogous patient cohorts.