Embolic Stroke Unveiling Lung Cancer: A Case of Cancer-Associated Non-bacterial Thrombotic Endocarditis

TL;DR

A 71-year-old man with a stroke was found to have lung cancer causing a rare heart condition that led to blood clots.

Contribution

This case highlights the importance of considering cancer as a cause of stroke through non-bacterial thrombotic endocarditis.

Findings

A cardiac mass was identified as non-bacterial thrombotic endocarditis linked to lung cancer.

The patient's stroke was determined to be cardioembolic in origin due to malignancy-induced hypercoagulability.

Abstract

We discuss the case of a 71-year-old male with various comorbidities who presented to the Emergency Department for prostration and gait abnormalities. Neurological assessment and imaging studies revealed a multi-territorial ischemic stroke. Further investigation identified a cardiac mass, raising suspicion of non-bacterial thrombotic endocarditis (NBTE), after ruling out infectious causes. Further investigation, a thoracoabdominopelvic computed tomography (CT) scan revealed a pulmonary mass, confirmed as non-small cell lung carcinoma. The final diagnosis was cardioembolic stroke secondary to NBTE, associated with a hypercoagulable state induced by malignancy. The patient was started on therapeutic anticoagulation and referred for multidisciplinary management.

This case underscores the significance of NBTE in stroke cases, highlighting the importance of early consideration of malignancy. Early identification is crucial for prompt initiation of appropriate treatment.

Figures