# Recurrent Cancer-Associated Nonbacterial Endocarditis Presenting With Systemic Embolic Complications

## TL;DR

A woman with ovarian cancer developed recurring heart valve issues linked to her cancer, despite treatment, highlighting the challenges of managing such cases.

## Contribution

This case presents a rare instance of recurrent nonbacterial endocarditis in a cancer patient with systemic embolic complications.

## Key findings

- The patient developed NBTE with recurrent vegetations on different heart valves despite anticoagulation therapy.
- Cancer recurrence was associated with new NBTE manifestations and embolic events.
- The case underscores the need for vigilant monitoring and tailored anticoagulation strategies in hypercoagulable malignancies.

## Abstract

Nonbacterial thrombotic endocarditis (NBTE) is a rare complication of malignancy, often leading to systemic embolization.

A 52-year-old woman presented with embolic ischemic stroke, multiple systemic infarctions, a pelvic mass, and aortic valve vegetations. The pelvic mass was completely resected and was subsequently diagnosed as ovarian clear cell carcinoma. The valvular vegetations were identified as NBTE. Despite ongoing anticoagulation therapy with edoxaban, she developed recurrent vegetations on the mitral valves in association with cancer recurrence. Based on the patient's preference, anticoagulation therapy with edoxaban was continued. She later experienced an upper limb arterial embolism and died after 3 months.

This case highlights the diagnostic and therapeutic challenges of NBTE in cancer patients, particularly in the context of temporally distinct recurrences involving different cardiac valves despite appropriate oncologic and anticoagulant therapy.

Vigilant valvular monitoring and individualized anticoagulation strategies are necessary when managing patients with hypercoagulable malignancies.