SHM Converge Scientific Abstract ePoster Gallery-A Murmur of Malignancy: Marantic Endocarditis in a Patient With Pancreatic Cancer

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This case report describes marantic endocarditis, a rare non-infectious endocarditis associated with advanced malignancy and hypercoagulability. It most commonly affects the aortic and mitral valves and can lead to embolic complications such as stroke or systemic thrombosis.  <br /><br />A 57-year-old man with stage IV metastatic pancreatic adenocarcinoma presented with one day of bilateral leg swelling and chest pain, along with dry cough. His history also included coronary artery disease with prior stenting, previous DVT, hypertension, hyperlipidemia, and pancreatic insufficiency with diabetes. On exam, he had a new systolic murmur, mild ankle edema, and epigastric tenderness. Laboratory studies showed anemia, thrombocytopenia, leukopenia, and markedly elevated liver enzymes and bilirubin.  <br /><br />Imaging revealed acute pulmonary emboli and multiple acute deep vein thromboses in the lower extremities. Transthoracic echocardiography showed a large mobile density on the non-coronary cusp of the aortic valve, consistent with vegetation. Blood cultures were negative, and antibiotics were stopped after infection became unlikely. The patient was started on heparin infusion for thrombosis. Further evaluation with TEE and brain MRI was considered but deferred after the patient chose hospice because of poor cancer prognosis.  <br /><br />The report emphasizes that marantic endocarditis should be considered in hospitalized cancer patients with new murmurs, chest pain, venous thromboembolism, stroke, or altered mental status. Diagnosis relies on excluding infection and recognizing the thrombotic setting, while management typically includes anticoagulation and, in select cases, valve surgery.

Asset Subtitle

Ali Farkhondehpour

Meta Tag

Author List Ali Farkhondehpour, Lobna Shahatto, Sarah F. Horman, William D. Keen Jr.

Category Clinical Vignettes

Concept Marantic Endocarditis

Concept Advanced Malignancy

Concept Vegetation

Concept Echocardiography

Concept Underlying Malignancy

Distinguished Non-Finalist

Presenter Organization University of California San Diego

Presenting Author Ali Farkhondehpour

Track Adult

Keywords

marantic endocarditis

non-infectious endocarditis

metastatic pancreatic adenocarcinoma

aortic valve vegetation

hypercoagulability

pulmonary embolism

deep vein thrombosis

negative blood cultures

anticoagulation

embolic complications

Marantic Endocarditis

Advanced Malignancy

Vegetation

Echocardiography

Underlying Malignancy