A CASE OF MARANTIC ENDOCARDITIS OF THE AORTIC VALVE IN A PATIENT WITH METASTATIC COLON CANCER
Recommended Citation
Gregerson S, Rana F, Mahmood S, Almajed MR, Obri M, Stephan J, and Russell C. A CASE OF MARANTIC ENDOCARDITIS OF THE AORTIC VALVE IN A PATIENT WITH METASTATIC COLON CANCER. J Am Coll Cardiol 2023; 81(8):2999.
Document Type
Conference Proceeding
Publication Date
3-7-2023
Publication Title
J Am Coll Cardiol
Abstract
Background: A 74-year-old male with history of coronary artery disease and complex peripheral arterial disease presented to our emergency department with shortness of breath and melena.
Case: The patient presented with a two-week history of shortness of breath and melena. Physical exam was significant for a 4/6 systolic ejection murmur at the left sternal border and cold lower extremities with diminished pedal pulses. Laboratory evaluation revealed hemoglobin of 5.8 g/dL and CEA level > 950 ng/mL. CT scan of the abdomen demonstrated findings concerning for metastatic disease to the liver and concern for peritoneal carcinomatosis. Subsequently, colonoscopy demonstrated a large ascending colonic mass with biopsy revealing invasive, poorly-differentiated carcinoma. A transesophageal echocardiogram (TEE) revealed large (1.35 cm x 0.29 cm) highly mobile sub-valvular and valvular-proper aortic vegetations. Serial blood cultures were negative, including HACEK organisms. Patient's course was complicated with development of scattered, punctate erythematous macules of the right foot consistent with emboli.
Decision-making: Given TEE findings and diagnosis of colonic adenocarcinoma, the initial leading diagnosis was aortic valve endocarditis. After infectious etiologies were excluded, the presumptive diagnosis of marantic endocarditis with thromboemboli was made. Antibiotics were stopped and the patient was started on anticoagulation.
Conclusion: Marantic endocarditis is a rare, noninfectious endocarditis. It predominantly affects the mitral and aortic valves, with deposition of platelet thrombi. Advanced malignancies of the lung and gastrointestinal tract comprise a majority of cases, yet most cases are diagnosed at autopsy. Antemortem cases most commonly present with thromboembolic phenomena. We describe an antemortem case of aortic valve marantic endocarditis in a patient with advanced colon adenocarcinoma who developed thromboembolic sequela.
Volume
81
Issue
8
First Page
2999
