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The patient progressively developed worsening neurological dysfunction and subconjunctival haemorrhage from recurrent embolic complications despite empirical antimicrobial treatment. Histology finally revealed lung adenocarcinoma after delay in obtaining biopsy due to high procedural risk from recurrent stroke. Unfortunately, before the patient could undergo any systemic oncology treatment, he deteriorated with type I respiratory failure from obstructive pneumonia and eventually demised. Important lessons include the need to consider non-bacterial thrombotic endocarditis as a differential in the appropriate clinical context followed by anticoagulation with systemic treatment as early as possible.<\/jats:p>","DOI":"10.1136\/bcr-2021-242948","type":"journal-article","created":{"date-parts":[[2021,7,27]],"date-time":"2021-07-27T11:27:07Z","timestamp":1627385227000},"page":"e242948","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Non-bacterial thrombotic endocarditis and metastatic lung adenocarcinoma"],"prefix":"10.1136","volume":"14","author":[{"given":"Yi","family":"Zhou","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Singapore General Hospital, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3620-1811","authenticated-orcid":false,"given":"Yucai","family":"Yee","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Singapore General Hospital, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yan","family":"Qin","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Singapore General Hospital, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,7,27]]},"reference":[{"key":"2025082711142214000_14.7.e242948.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra010082"},{"key":"2025082711142214000_14.7.e242948.2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.43.10.5238-5242.2005"},{"key":"2025082711142214000_14.7.e242948.3","unstructured":"Bauer KA . 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