title: Stroke and a valvular lesion in a patient with stage IV non-small cell lung cancer.
abstract: The mechanism and severity of stroke varies in the setting of malignancy. We report a case of a 68-year-old man with lung adenocarcinoma, who experienced acute neurological symptoms. Imaging studies showed multiple acute ischaemic infarcts in cerebral and cerebellar hemispheres. Further work up was consistent with non-bacterial thrombotic endocarditis (NBTE). We highlight, through a review of the literature, the importance of transoesophageal echocardiography (TOE) in defining the above diagnosis. The treatment of NBTE consists of systemic anticoagulation and therapy of the underlying malignancy. Enoxaparin is preferred over warfarin to achieve this goal. He received systemic targeted therapy with erlotinib. A TOE performed 8 months later showed complete resolution of the vegetation.
authors.affiliation: Department of Internal Medicine, Bridgeport Hospital, Bridgeport, Connecticut, USA Yale University School of Medicine, New Haven, Connecticut, USA.
authors.forename: Angel A
authors.initials: AA
authors.lastname: Mitma
authors.affiliation: Department of Internal Medicine, Bridgeport Hospital, Bridgeport, Connecticut, USA.
authors.forename: Jithin G
authors.initials: JG
authors.lastname: Varghese
authors.affiliation: Yale University School of Medicine, New Haven, Connecticut, USA Yale Smilow Cancer Hospital, New Haven, Connecticut, USA.
authors.forename: David
authors.initials: D
authors.lastname: Witt
authors.affiliation: Yale University School of Medicine, New Haven, Connecticut, USA Department of Cardiology, Bridgeport Hospital, Bridgeport, Connecticut, USA.
authors.forename: Stuart W
authors.initials: SW
authors.lastname: Zarich
mesh_terms: D000230:Adenocarcinoma / Q000150:complications* / Q000175:diagnosis; D000077192:Adenocarcinoma of Lung; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D002531:Cerebellum / Q000503:physiopathology; D003937:Diagnosis, Differential; D017548:Echocardiography, Transesophageal; D059905:Endocarditis, Non-Infective / Q000150:complications* / Q000000981:diagnostic imaging; D017984:Enoxaparin / Q000627:therapeutic use*; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications* / Q000175:diagnosis; D008297:Male; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D014057:Tomography, X-Ray Computed
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin