# Carcinoid Heart Disease: A Classic One, But Not Always Remembered

## TL;DR

A young woman with a skin condition was later diagnosed with carcinoid heart disease caused by a neuroendocrine tumor, requiring surgery and medication.

## Contribution

This case highlights the importance of considering rare causes of heart failure in young patients with atypical presentations.

## Key findings

- Transthoracic echocardiography revealed thickened and stiff heart valves causing severe regurgitation.
- PET/CT imaging identified liver metastases from a well-differentiated neuroendocrine tumor.
- Treatment with lanreotide and valve replacement improved the patient's condition.

## Abstract

A 24-year-old female presented a dermatosis characterized by confluent erythematous spots on her face and neck and was diagnosed with presumed systemic lupus erythematosus. Five years later, she was admitted to our Cardiology Department due to symptoms of right heart failure (fatigue, dyspnea, edema in inferior limbs, and ascites). Thickened, stiff tricuspid and pulmonary valve leaflets that caused severe tricuspid and pulmonary regurgitation were seen on transthoracic echocardiography. Cardiac magnetic resonance showed right heart dilatation and right ventricular dysfunction. Multimodal imaging with contrast-enhanced computed tomography and dual positron emission tomography (PET/CT) with (18F) fluorodeoxyglucose and (18F) AlF-NOTA-octreotide showed liver lesions highly suggestive of metastasis. The liver biopsy confirmed a well-differentiated neuroendocrine tumor. A diagnosis of carcinoid heart disease (CHD) was made. She was treated with lanreotide (a long-acting somatostatin analog) and surgical replacement of the tricuspid and pulmonary valves.