Mesothelioma with Nonbacterial Thrombotic Endocarditis: A Case Report

Our plain-English summary of Mesothelioma with Nonbacterial Thrombotic Endocarditis: A Case Report, by A. Verma, N. Bhatta, D.R. Mishra, et al (JNMA; Journal of the Nepal Medical Association, 2021).

The study

• Authors: A. Verma, N. Bhatta, D.R. Mishra, A.B. Acharya, R. Shahi, S.H. LImbu, S. Katuwal, U. Lama
• Journal: JNMA; Journal of the Nepal Medical Association
• Published: 2021;59(243):1170-1173
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Non-bacterial thrombotic endocarditis is a rare condition characterized by noninfectious vegetation on cardiac valves which are often associated with malignancy. It often presents with features of embolism rather than cardiac failure. These are usually seen in autoimmune conditions, disseminated intravascular coagulation, malignancy of gut and lung but has also been reported in other malignancies as well. This entity is rare but one must have a clinical suspicion of the disease especially in a patient suffering from malignancy presenting with the embolic phenomenon. In this report, we are presenting a case of non-bacterial thrombotic endocarditis in an inpatient with pleural mesothelioma, a rare malignant neoplasm arising from pleura in a 35 years old mason, and a rare association as well.

In plain English

This was a case report of one patient from B. P. Koirala Institute of Health Sciences in Dharan, Nepal. He was a 35-year-old mason with 20 years of cement exposure and a 20 pack-year smoking history. He came to the emergency department with dry cough and right-sided chest pain and had a large right-sided collection of bloody fluid around the lung. On his 5th hospital day he had a stroke. A heart ultrasound showed an 8.4 by 6 mm growth (vegetation) on the mitral valve. Blood cultures were negative, and so were tests for autoimmune disease, clotting disorders and HIV. Doctors diagnosed non-bacterial (marantic) endocarditis and started the blood thinner enoxaparin. A biopsy showed epithelioid malignant pleural mesothelioma, and he received carboplatin and pemetrexed. On day 15 he had severe abdominal pain and unrecordable blood pressure. The patient and his relatives refused further tests, and he collapsed. The article did not mention asbestos. The authors believed this was the first reported case linking mesothelioma with this condition.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 35-year-old male mason seen at B. P. Koirala Institute of Health Sciences, Dharan, Nepal
• Exposure: Cement exposure for 20 years as a mason and a 20 pack-year smoking history. Asbestos is not mentioned in the article.
• Main results:
  • The patient had a massive right-sided pleural effusion. About 3 L of bloody fluid was drained, and drainage of more than 500 ml per day continued afterwards.
  • On the 5th day of admission the patient had an acute ischemic stroke, with infarcts in the right parietal lobe and left cerebellum.
  • Transthoracic echocardiography showed an 8.4 by 6 mm vegetation on the anterior leaflet of the mitral valve, with mitral regurgitation.
  • Blood cultures were negative. Workup for autoimmune disease, connective tissue disorder, coagulopathy and HIV was negative. Marantic endocarditis with systemic embolization was diagnosed and full-dose enoxaparin was started.
  • Pleural biopsy showed epithelioid mesothelioma, positive for calretinin and cytokeratin 5/6. Carboplatin and pemetrexed were given on the 12th day.
  • On day 15 the patient had severe abdominal pain and unrecordable blood pressure, and possible mesenteric ischemia was suspected. Further workup was refused and the patient collapsed.
• The authors' conclusion: The authors stated that, to their knowledge, this was the first case report of mesothelioma with NBTE. They concluded that NBTE should be considered in any cancer patient presenting with embolic events.
• Limitations the authors state:
  • The patient's relatives declined further workup for mesenteric ischemia, which would have given a fuller clinical picture.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Mesothelioma, Pleural Mesothelioma, Neoplasm, Pleura.

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