Nonbacterial thrombotic endocarditis - Not forgotten

We report the case of a 36-year-old man who presented with an incidental echocardiographic finding of a 1.1 × 0.8 cm mobile structure on the mitral valve associated with mild to moderate eccentric jet of mitral regurgitation. Surgical excision confirmed the diagnosis of nonbacterial thrombotic endocarditis (NBTE), formerly known as marantic endocarditis. The cardiolipin IgG and IgM antibodies and the lupus anticoagulant were strongly positive confirming the diagnosis of antiphospholipid syndrome. The patient was promptly anticoagulated. NBTE is a rare condition associated with advanced mucin secreting malignant tumours and hypercoagulable states. It is associated with high incidence of embolic events the most frequent ones being cerebral; the diagnosis is usually reached at post-mortem. Our case clearly demonstrates that vegetations on cardiac valves may pose a diagnostic dilemma and surgical intervention may be needed to reach a diagnosis. We propose that in patients with high likelihood of NBTE a transthoracic echocardiogram should be considered to assess for the above diagnosis which carries a high risk of life threatening embolic events. Anticoagulation or surgical excision is likely to improve cardiovascular outcome.