Author(s) :

Claudia Florina, Maria Francesca, Andreea Maria, Alexandru.

Volume/Issue :

Abstract :

Hypercoagulability is a common complication in pancreatic cancer, and nonbacterial thrombotic endocarditis (NBTE), or marantic endocarditis, is a frequently underdiagnosed manifestation of this prothrombotic state. It can lead to significant morbidity, especially through recurrent ischemic cerebrovascular events. We report the case of a 62-year-old male diagnosed with pancreatic adenocarcinoma and liver metastases, initially investigated for deep venous thrombosis (DVT). Following the diagnosis, the patient was treated with palliative polychemotherapy (PCT). However, before the second cycle of PCT, he developed neurological symptoms, including dysarthria and paresthesia, which were later confirmed to be due to ischemic strokes. Further investigation, including transesophageal echocardiography, revealed a vegetation on the anterior mitral valve, consistent with marantic endocarditis. Blood cultures were negative, so the diagnosis of NBTE was confirmed. A review of recent literature on pancreatic cancer complicated by NBTE was conducted, revealing common clinical manifestations, predominantly ischemic cerebral strokes and thrombotic episodes. The majority of NBTE diagnoses in the published cases occurred before cancer diagnosis, often in advanced stages with liver metastasis. Despite anticoagulation therapy, recurrent thromboembolic events were common. This case highlights the need for heightened awareness of marantic endocarditis in cancer patients, as neurological symptoms may obscure the underlying malignancy. Early recognition and multidisciplinary management are crucial for improving patient outcomes.

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