title: Nonbacterial thrombotic endocarditis as the sole manifestation of stage IV gastric cancer: a case report.
abstract: BACKGROUND
  Nonbacterial thrombotic endocarditis is a very rare complication of malignancy and other hypercoagulable states. It describes the deposition of small sterile smooth or verrucoid vegetations on the valve leaflets, causing a clinical picture similar to that of bacterial endocarditis. The authors reported this case because this is a rare and unusual first manifestation of malignancy generally and of gastric cancer particularly, with only a few reports present in the literature.
  
  
  METHODS
  The authors present a case of a 36-year-old Caucasian male with occult gastric cancer whose first and only manifestation was nonbacterial thrombotic endocarditis causing extensive multi-organ infarctions.
  
  
  CONCLUSIONS
  An endocarditis not responsive to antibiotics should raise the suspicion of an occult malignancy. Differentiating between an infective endocarditis and a nonbacterial thrombotic endocarditis will cause a radical change in the management which will eventually affect the patient's prognosis.
authors.forename: Wassim
authors.initials: W
authors.lastname: Shatila
authors.forename: Alain
authors.initials: A
authors.lastname: Rizkallah
authors.forename: Ehab Saad
authors.initials: ES
authors.lastname: Aldin
authors.affiliation: Division of Hematology/Oncology, American University of Beirut Medical Center, PO Box 11-0236, Riad El-Solh 1107-2020 Beirut, Lebanon. at35@aub.edu.lb.
authors.forename: Arafat
authors.initials: A
authors.lastname: Tfayli
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000473:pathology*; D000328:Adult; D059905:Endocarditis, Non-Infective / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D013274:Stomach Neoplasms / Q000150:complications / Q000473:pathology*; D019851:Thrombophilia / Q000097:blood* / Q000209:etiology; D014463:Ultrasonography
references.citation: Stroke. 1991 Jun;22(6):734-9
references.pmid: 2057971
references.citation: Am Heart J. 1976 Dec;92(6):723-9
references.pmid: 998478
references.citation: J Gen Intern Med. 2006 Dec;21(12):C12-5
references.pmid: 16965557
references.citation: Rev Med Interne. 2008 Aug;29(8):673-5
references.pmid: 18304702
references.citation: Ann Thorac Surg. 2005 Jun;79(6):2145-7
references.pmid: 15919332
references.citation: J Clin Oncol. 2008 Mar 10;26(8):1383-5
references.pmid: 18323562
references.citation: N Engl J Med. 2003 Jul 10;349(2):109-11
references.pmid: 12853582
references.citation: Oncologist. 2007 May;12(5):518-23
references.pmid: 17522239
references.citation: Arch Neurol. 1982 Feb;39(2):95-8
references.pmid: 7059307
references.citation: Br Med J. 1978 Jan 28;1(6107):197-8
references.pmid: 620264
references.citation: Cardiol Res Pract. 2010;2010:319732
references.pmid: 20614001
references.citation: Stroke. 2002 May;33(5):1267-73
references.pmid: 11988602