{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T15:01:38Z","timestamp":1770822098133,"version":"3.50.1"},"reference-count":15,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2021,11,18]],"date-time":"2021-11-18T00:00:00Z","timestamp":1637193600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Valve vegetation is one of the most fearful findings for physicians. The first diagnosis that comes to their mind is infective endocarditis (IE), but it can also be noninfective; nonbacterial thrombotic endocarditis (NBTE). NBTE can be even more challenging than IE for physicians because of the wide range of differential diagnoses such as malignancies, autoimmune disorders and human immunodeficiency virus. A 45-year-old woman presented at the emergency room with a sudden onset of dysarthria and right-sided hemiplegia. Laboratory data showed her blood counts and coagulation test were mostly normal and the magnetic resonance imaging detected a high-signal-intensity change in her left brain. An echocardiogram found a vegetation-like structure on her atrial valve. We highly suspected IE leading to cerebral embolism. The clot was successfully removed by our neurosurgeons and anticoagulation therapy was started concurrently. Her state of consciousness improved, but then she suffered a brain hemorrhage and died. The autopsy revealed that the cause of her vegetation was acute promyelocytic leukemia (APL). Based on these findings, it is important to remember that APL can be the cause of NBTE even if the blood count and coagulation tests are almost normal.<\/jats:p>","DOI":"10.3390\/medicina57111264","type":"journal-article","created":{"date-parts":[[2021,11,18]],"date-time":"2021-11-18T08:53:56Z","timestamp":1637225636000},"page":"1264","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Nonbacterial Thrombotic Endocarditis Associated with Acute Promyelocytic Leukemia: An Autopsy Case Report"],"prefix":"10.3390","volume":"57","author":[{"given":"Tadayuki","family":"Hashimoto","sequence":"first","affiliation":[{"name":"Department of General Internal Medicine, Hashimoto Municipal Hospital, Hashimoto 648-0005, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tatsuya","family":"Aoki","sequence":"additional","affiliation":[{"name":"Department of General Internal Medicine, Hashimoto Municipal Hospital, Hashimoto 648-0005, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshitaka","family":"Kawabata","sequence":"additional","affiliation":[{"name":"Hinata Medical Clinic, Osaka 543-0062, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3234-1822","authenticated-orcid":false,"given":"Yoshihiro","family":"Owai","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hashimoto Municipal Hospital, Hashimoto 648-0005, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3817-8918","authenticated-orcid":false,"given":"Yoshikazu","family":"Matsuda","sequence":"additional","affiliation":[{"name":"Showa University Fujigaoka Hospital, Yokohama 227-8501, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1150-0970","authenticated-orcid":false,"given":"Shinobu","family":"Tamura","sequence":"additional","affiliation":[{"name":"Department of Hematology\/Oncology, Wakayama Medical University, Wakayama 641-8509, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,11,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1016\/j.ejcts.2007.07.029","article-title":"Non-bacterial Thrombotic Endocarditis","volume":"32","author":"Asopa","year":"2007","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1136\/heartjnl-2019-315204","article-title":"Non-infective Endocarditis","volume":"106","author":"Hurrell","year":"2020","journal-title":"Heart"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1016\/0002-8703(87)90719-8","article-title":"Nonbacterial Thrombotic Endocarditis: A Review","volume":"113","author":"Lopez","year":"1987","journal-title":"Am. Heart J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1016\/S0002-9343(96)00457-3","article-title":"Cardiac Valvular Vegetations in Cancer Patients: A Prospective Echocardiographic Study of 200 patients","volume":"102","author":"Edoute","year":"1997","journal-title":"Am. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.12968\/hmed.2020.0696","article-title":"Multiple Cerebral Infarction Linked to Underlying Cancer: A Review of Trousseau Syndrome-related Cerebral Infarction","volume":"82","author":"Zhen","year":"2021","journal-title":"Br. J. Hosp. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1267","DOI":"10.1161\/01.STR.0000015029.91577.36","article-title":"Acute Ischemic Stroke Patterns in Infective and Nonbacterial Thrombotic Endocarditis: A Diffusion-weighted Magnetic Resonance Imaging Study","volume":"33","author":"Singhal","year":"2002","journal-title":"Stroke"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1634\/theoncologist.12-5-518","article-title":"Nonbacterial Thrombotic Endocarditis in Cancer Patients: Pathogenesis, Diagnosis, and Treatment","volume":"12","author":"Griffiths","year":"2007","journal-title":"Oncologist"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1016\/j.amjmed.2020.06.047","article-title":"A Contemporary 20-Year Cleveland Clinic Experience of Nonbacterial Thrombotic Endocarditis: Etiology, Echocardiographic Imaging, Management, and Outcomes","volume":"134","author":"Zmaili","year":"2021","journal-title":"Am. J. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"632","DOI":"10.3904\/kjim.2016.135","article-title":"Histologically Confirmed Nonbacterial Thrombotic Endocarditis in a Febrile Leukemic Patient","volume":"33","author":"Jeong","year":"2018","journal-title":"Korean J. Intern. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"61","DOI":"10.17161\/kjm.v13i1.13531","article-title":"Nonbacterial Thrombotic Endocarditis","volume":"13","author":"Parker","year":"2020","journal-title":"Kansas J. Med."},{"key":"ref_11","first-page":"3395","article-title":"Causes and Prognostic Factors of Remission Induction Failure in Patients with Acute Promyelocytic Leukemia Treated with All-trans retinoic acid and Idarubicin","volume":"111","author":"Montesinos","year":"2008","journal-title":"Blood J. Am. Soc. Hematol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1630","DOI":"10.1182\/blood-2019-01-894980","article-title":"Management of Acute Promyelocytic Leukemia: Updated Recommendations From an Expert Panel of the European LeukemiaNet","volume":"133","author":"Sanz","year":"2019","journal-title":"Blood"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"jez319.314","DOI":"10.1093\/ehjci\/jez319.314","article-title":"Recovery of Non-bacterial Thrombotic Endocarditis and Severe Aortic Regurgitation in a Young Patient with Acute Promyelocytic Leukemia","volume":"21","author":"Kuffer","year":"2020","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1002\/mpo.1322","article-title":"Automated Differential Counts in Acute Promyelocytic Leukemia Patients May be Misleading","volume":"38","author":"Kapelushnik","year":"2002","journal-title":"Med. Pediatr. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1493","DOI":"10.1001\/archinte.165.13.1493","article-title":"Diagnostic Error in Internal Medicine","volume":"165","author":"Graber","year":"2005","journal-title":"Arch. Intern. Med."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/57\/11\/1264\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:32:04Z","timestamp":1760167924000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/57\/11\/1264"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,18]]},"references-count":15,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2021,11]]}},"alternative-id":["medicina57111264"],"URL":"https:\/\/doi.org\/10.3390\/medicina57111264","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,18]]}}}