LIBMAN-SACKS ENDOCARDITIS AS THE INITIAL PRESENTATION OF METASTATIC GASTRIC ADENOCARCINOMA

TOPIC: Cardiovascular Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Nonbacterial thrombotic endocarditis (NBTE), "marantic", or "Libman-Sacks" is a rare entity describing that non-infectious and usually secondary to advanced malignancy, systemic lupus erythematosus (SLE), anti-phospholipid antibody syndrome. NBTE found on autopsy, however some patients are diagnosed antemortem. If clinical signs symptoms suggestive, high index of suspicion needed diagnosis NBTE. We present case unclear etiology later determined be as the initial manifestation metastatic gastric adenocarcinoma. CASE PRESENTATION: 63-year-old female with past medical history recently pulmonary embolism (PE) multivessel deep vein thromboses (DVT's) apixaban presented dyspnea chest tightness. She was have macrocytic anemia, bilateral pleural effusions, extensive lymphadenopathy, splenic infarcts. Transesophageal echocardiogram showed severe mitral regurgitation two large valve vegetations suggestive Libman-Sacks endocarditis. Four sets blood cultures had no growth during hospitalization, other atypical causes infectious were ruled out. Rheumatological work-up nonrevealing including SLE Thoracentesis right left effusions demonstrated adenocarcinoma, likely an upper gastrointestinal source. An esophagogastroduodenoscopy (EGD) performed which ulcerated lesion in body stomach biopsied poorly differentiated adenocarcinoma signet ring cell features. Her hospital course complicated by recurrent deterioration. Patient subsequently transitioned comfort measures passed away shortly after. DISCUSSION: In most cases nonbacterial endocarditis, known pre-existing disease process such malignancy lead this case, investigation eventually led discovery cancer correct Infectious causes, organisms culture-negative must out diagnose CONCLUSIONS: When without clear etiology, considered. The crucial treatment neoplasm consists anticoagulation well directed against underlying malignancy. REFERENCE #1: Deppisch LM, Fayemi AO. Non-bacterial endocarditis: clinicopathologic correlations. Am Heart J 1976; 92:723. #2: el-Shami K, Griffiths E, Streiff M. patients: pathogenesis, diagnosis, treatment. Oncologist 2007; 12:518. DISCLOSURES: No relevant relationships Michelle Helbig, source=Web Response Prashant Patel,