Nonbacterial thrombotic endocarditis clinically mimicking veno-occlusive disease of the liver complicating autologous bone marrow transplantation.
Nonbacterial thrombotic endocarditis is an uncommon, but well-described, complication of bone marrow transplantation. We describe a case of nonbacterial thrombotic endocarditis following autologous bone marrow transplantation that was marked by weight gain, hepatomegaly, ascites, and extreme hyperbilirubinemia leading to a clinical diagnosis of hepatic veno-occlusive disease. Autopsy revealed nonbacterial thrombotic endocarditis of the tricuspid and pulmonic valves, and passive congestion of the liver, but there was no evidence of veno-occlusive disease. We discuss the pathophysiology and clinical features of nonbacterial thrombotic endocarditis and review its occurrence in association with bone marrow transplantation. Nonbacterial thrombotic endocarditis is often difficult to detect clinically and should be a diagnostic consideration in patients who develop systemic emboli or congestive heart failure after bone marrow transplantation.
Vukelja
S J
SJ
Department of Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas 78234-6200.
Baker
W J
WJ
Jeffreys
P
P
Reeb
B A
BA
Pick
T
T
D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D003937:Diagnosis, Differential; D004696:Endocarditis / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006504:Hepatic Veno-Occlusive Disease / Q000175:diagnosis*; D006801:Humans; D008875:Middle Aged; D013927:Thrombosis / Q000175:diagnosis / Q000209:etiology; D014182:Transplantation, Autologous