Strokes and Diagnostic Dilemmas: Non-bacterial Thrombotic Endocarditis Mimicking a Flail Mitral Valve

TL;DR

A rare heart condition called non-bacterial thrombotic endocarditis was mistaken for a flail mitral valve, causing a delay in treatment and leading to strokes.

Contribution

This case emphasizes the diagnostic challenges of NBTE and the need for timely anticoagulation to prevent complications.

Findings

NBTE was initially misdiagnosed as a flail mitral valve, delaying appropriate treatment.

The patient experienced multifocal strokes due to undiagnosed NBTE.

Early recognition and anticoagulation are critical in managing NBTE to prevent embolic events.

Abstract

Non-bacterial thrombotic endocarditis (NBTE) is a rare condition characterized by sterile vegetations on cardiac valves, commonly associated with malignancy or autoimmune disorders. These vegetations pose a significant risk of embolization, leading to adverse complications such as ischemic stroke. We present a case of a 60-year-old female initially suspected of having a brain tumor, later diagnosed with multifocal strokes due to NBTE. Initial interpretation of a flail mitral valve was subsequently revised to NBTE on further assessment, but this resulted in a delay of anticoagulation initiation. This case highlights the importance of early recognition and multidisciplinary management of NBTE to prevent recurrent embolic events, highlighting the diagnostic challenges and the role of anticoagulation in its treatment.

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