Nonbacterial Thrombotic Endocarditis of mitral valve associated with a lymphoproliferative malignancy: Case Report and Literature Review

Abstract

Abstract Non-bacterial thrombotic endocarditis (NBTE) is a rare condition marked by sterile vegetations on cardiac valves, often linked to rheumatologic diseases, autoimmune disorders, and advanced solid malignancies. It poses a high risk of systemic embolization, and treatment and prognosis depend on the underlying clinical condition. We present a case of a 57 years-old male who presented to the emergency department with a 5-day history of painful swollen fingers and color change episodes (from pallor to cyanosis). The patient also reported unintentional weight loss and weakness over two months. Physical examination revealed erythrocyanosis in the distal extremities, prompting consideration of secondary Raynaud syndrome. Despite medical therapy, progressive digital ischemia led to multiple finger amputations. Diagnostic work-up, including a transesophageal echocardiogram, identified an irregular hyperechogenic mass on the mitral valve (scallops A1/A2) without valve disfunction. A thoracic computed tomography scan showed an enlarged right paratracheal lymph node. Histopathological analysis from a transthoracic needle biopsy revealed diffuse large B-cell lymphoma. The patient underwent aggressive R-CHOP chemotherapy, achieving a favorable complete response. This is a particular case involving the occurrence of NBTE and Raynaud phenomenon as the initial paraneoplastic manifestations in a previously healthy young man. Reports of NBTE associated with lymphoproliferative conditions are quite rare, with fewer than ten cases described in the literature. To our knowledge, this is the first case of NBTE specifically associated with diffuse large B-cell lymphoma.