Nonbacterial thrombotic endocarditis demonstrated by repeat echocardiography.
We report a case of nonbacterial thrombotic endocarditis (NBTE) in a patient with bladder cancer presenting with multiple cerebral infarctions. Initial transthoracic and transesophageal echocardiography did not show any abnormalities. However, repeat transthoracic and transesophageal echocardiography demonstrated a vegetation on the anterior leaflet of the mitral valve with mild mitral regurgitation and no evidence of leaflet destruction. Persistent high-grade fevers and leukocytosis were observed. The patient was suspected to have infective endocarditis. However, abdominal ultrasound and computed tomography scan revealed multiple metastatic masses, and serial blood cultures were negative. The patient was ultimately diagnosed with NBTE associated with multiple metastases of bladder cancer. This case suggests that even if echocardiography does not initially demonstrate any abnormalities in patients with embolism, it must be repeated at the recurrence of embolism, and that even if clinical signs of infection are documented, NBTE should be suspected in any cancer patient with thromboembolic events.
Division of Cardiology, Tokuyama Central Hospital, 1-1 Kodacho, Shunan, 745-8522, Japan. hytch@hotmail.co.jp.
Yasuyuki
Y
Hadano
Division of Cardiology, Tokuyama Central Hospital, 1-1 Kodacho, Shunan, 745-8522, Japan.
Hiroshi
H
Ogawa
Division of Cardiology, Tokuyama Central Hospital, 1-1 Kodacho, Shunan, 745-8522, Japan.
Takatoshi
T
Wakeyama
Division of Cardiology, Tokuyama Central Hospital, 1-1 Kodacho, Shunan, 745-8522, Japan.
Takahiro
T
Iwami
Division of Cardiology, Tokuyama Central Hospital, 1-1 Kodacho, Shunan, 745-8522, Japan.
Masayasu
M
Kimura
Division of Cardiology, Tokuyama Central Hospital, 1-1 Kodacho, Shunan, 745-8522, Japan.
Mamoru
M
Mochizuki
Division of Cardiology, Tokuyama Central Hospital, 1-1 Kodacho, Shunan, 745-8522, Japan.
Takeshi
T
Nakamura
Division of Cardiology, Tokuyama Central Hospital, 1-1 Kodacho, Shunan, 745-8522, Japan.
Takayoshi
T
Kato
Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan.
Masunori
M
Matsuzaki
Bladder cancer; Echocardiography; Nonbacterial thrombotic endocarditis