BMJ Case Reports 2018; doi:10.1136/bcr-2017-223860
  • Rare disease

A case of tricuspid valve non-bacterial thrombotic endocarditis presenting as pulmonary embolism in a patient with antiphospholipid antibody syndrome

  1. Chandler Patton
  1. Department of Internal Medicine, Monmouth Medical Center, Long Branch, New Jersey, USA
  1. Correspondence to Dr Dileep Unnikrishnan, drdileepunni{at}
  • Accepted 22 February 2018
  • Published 13 March 2018


A 47-year-old woman with a medical history of Raynaud’s phenomenon presented with fever, cough and shortness of breath. She was found to have left lower lobe consolidation and pleural effusion and was treated as a case of pneumonia. During the hospital course, her respiratory status worsened, and she was intubated on the third hospital day. To investigate the high A–a gradient, a Computerized Tomographic Pulmonary Embolism (CTPE) study was done which identified a large left lower pulmonary artery embolism. She was also found to have a new murmur, and an echocardiogram demonstrated a large lesion on tricuspid valve. However, multiple sets of her blood cultures came back consistently negative. Alternative diagnoses for culture-negative endocarditis were considered, and a full set of rheumatological workup was done. Laboratory tests were suggestive of antiphospholipid syndrome, hence the diagnosis of tricuspid valve Libman-Sacks endocarditis was made.


  • Contributors I, Dileep Unnikrishnan, certify that neither this manuscript nor one with substantially similar content under my authorship has been published or is being considered for publication elsewhere I have access to any data upon which the manuscript is based and will provide such data upon request to the editors or their assignees. I agree to allow the corresponding author to correspond with the editorial office, to review the uncorrected proof copy of the manuscript; and to make decisions regarding release of information in the manuscript. I have given final approval of the submitted manuscript for which I take public responsibility for whole content. According to the definition given by the International Committee of Medical Journal Editors (ICMJE), me and all the authors listed above qualify for authorship based on making one or more of the substantial contributions to the intellectual content.We also certify that me, Dileep Unnikrishnan, Nasreen Shaikh, Ahmad Sharayah and Chandler Patton have each contributed in both the care of the patient and drafting the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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