{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T06:33:07Z","timestamp":1762929187169,"version":"3.44.0"},"reference-count":14,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,6,15]]},"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:p>Non-bacterial thrombotic endocarditis (NBTE) is a rare, non-infective endocarditis affecting cardiac structures, often associated with underlying conditions and is frequently overlooked or misdiagnosed.<\/jats:p>\n               <jats:p>We present the case of a man in his 50s who initially presented with symptoms concerning for myocardial ischaemia, and laboratory and ECG findings raised suspicion for a subacute non-ST-elevation myocardial infarction. Coronary angiography showed coronary sclerosis without significant stenoses and a dilated left ventricle with reduced systolic function. Transthoracic echocardiography revealed vegetations on a bicuspid aortic valve, while blood cultures were negative. Subsequent imaging identified a mass in the pancreatic head with liver metastases, confirmed as an adenocarcinoma by biopsy. The diagnosis of NBTE was established based on the presence of a malignancy, persistent negative blood cultures and the absence of laboratory signs of infection. Antibiotics were discontinued, and heparin therapy was initiated, emphasising NBTE as a paraneoplastic syndrome with a prothrombotic state without criteria for infectious endocarditis.<\/jats:p>","DOI":"10.1136\/bcr-2025-266289","type":"journal-article","created":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T04:01:48Z","timestamp":1754884908000},"page":"e266289","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Non-bacterial thrombotic endocarditis leading to the diagnosis of pancreatic adenocarcinoma"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3926-4279","authenticated-orcid":false,"given":"Aron","family":"Velco","sequence":"first","affiliation":[{"name":"Internal Medicine, University Hospital Zurich, Z\u00fcrich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthias Philip","family":"N\u00e4gele","sequence":"additional","affiliation":[{"name":"Cardiology, University Hospital Zurich, Z\u00fcrich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3126-8555","authenticated-orcid":false,"given":"Stjepan","family":"Jurisic","sequence":"additional","affiliation":[{"name":"Cardiology, University Hospital Zurich, Z\u00fcrich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-5129-2158","authenticated-orcid":false,"given":"Tommaso","family":"Guffi","sequence":"additional","affiliation":[{"name":"Internal Medicine, University Hospital Zurich, Z\u00fcrich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,7,8]]},"reference":[{"key":"2025082723490543000_18.7.e266289.1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-8703(87)90719-8"},{"key":"2025082723490543000_18.7.e266289.2","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.12-5-518"},{"key":"2025082723490543000_18.7.e266289.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcad.2022.10.009"},{"key":"2025082723490543000_18.7.e266289.4","doi-asserted-by":"crossref","first-page":"189","DOI":"10.4081\/monaldi.2013.5236","article-title":"Nonbacterial thrombotic endocarditis in pancreatic cancer","volume":"80","author":"Piovanelli","year":"2013","journal-title":"Monaldi Arch Chest Dis"},{"key":"2025082723490543000_18.7.e266289.5","doi-asserted-by":"crossref","unstructured":"Spurgeon L , Ispoglou S . Non-bacterial thrombotic endocarditis in pancreatic cancer and other high-risk malignancies: the case for prophylactic treatment. Oxf Med Case Reports 2021;2021. doi:10.1093\/omcr\/omab110","DOI":"10.1093\/omcr\/omab110"},{"key":"2025082723490543000_18.7.e266289.6","doi-asserted-by":"crossref","first-page":"137","DOI":"10.31083\/j.rcm2304137","article-title":"Nonbacterial Thrombotic Endocarditis: Presentation, Pathophysiology, Diagnosis and Management","volume":"23","author":"Al Chalaby","year":"2022","journal-title":"Rev Cardiovasc Med"},{"key":"2025082723490543000_18.7.e266289.7","doi-asserted-by":"crossref","unstructured":"Ahmed O , King NE , Qureshi MA , et al . Non-bacterial thrombotic endocarditis: a clinical and pathophysiological reappraisal. Eur Heart J 2024.:ehae788.","DOI":"10.1093\/eurheartj\/ehae788"},{"key":"2025082723490543000_18.7.e266289.8","unstructured":"2023 ESC guidelines for the management of endocarditis. 2023. Available: https:\/\/www.escardio.org\/Guidelines\/Clinical-Practice-Guidelines\/Endocarditis-Guidelines"},{"key":"2025082723490543000_18.7.e266289.9","unstructured":"Mazzolai L , Alatri A . Treatment of cancer-associated venous thromboembolism. 2025. Available: https:\/\/www.escardio.org\/Councils\/Council-for-Cardiology-Practice-(CCP)\/Cardiopractice\/treatment-of-cancer-associated-venous-thromboembolism"},{"key":"2025082723490543000_18.7.e266289.10","doi-asserted-by":"crossref","first-page":"1208190","DOI":"10.3389\/fcvm.2023.1208190","article-title":"Case report: New is not always better: treatment of non-bacterial thrombotic endocarditis","volume":"10","author":"Akiki","year":"2023","journal-title":"Front Cardiovasc Med"},{"key":"2025082723490543000_18.7.e266289.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.jjcc.2018.02.011"},{"key":"2025082723490543000_18.7.e266289.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2022.10.008"},{"key":"2025082723490543000_18.7.e266289.13","doi-asserted-by":"publisher","DOI":"10.4065\/76.12.1204"},{"key":"2025082723490543000_18.7.e266289.14","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1159\/000207195","article-title":"Marantic Endocarditis Associated with Pancreatic Cancer: A Case Series","volume":"3","author":"Jameson","year":"2009","journal-title":"Case Rep Gastroenterol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-266289","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T06:49:18Z","timestamp":1756363758000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-266289"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7]]},"references-count":14,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,7,8]]},"published-print":{"date-parts":[[2025,7]]}},"alternative-id":["10.1136\/bcr-2025-266289"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-266289","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2025,7]]}}}