BMJ Case Reports 2018; doi:10.1136/bcr-2018-224529
  • Unusual presentation of more common disease/injury

Marantic endocarditis: incidental infarcts leading to diagnosis of pancreatic cancer

  1. Serena Scott1
  1. 1 Internal Medicine, Banner University Medical Center Tucson, Tucson, Arizona, USA
  2. 2 College of Medicine, University of Arizona College of Medicine, Tucson, Arizona, USA
  1. Correspondence to Dr Ella Starobinska, elstar{at}, elstareras{at}
  • Accepted 25 May 2018
  • Published 12 June 2018


Non-bacterial thrombotic endocarditis (NBTE) is a well-described phenomenon associated with malignancies due to hypercoaguable state. In the setting of pancreatic cancer, NBTE is more commonly diagnosed postmortem. We describe a case of a man who was diagnosed with pancreatic carcinoma after incidental finding of NBTE. Imaging incidentally revealed multiple strokes, bilateral renal and splenic infarcts, while subsequent workup for cardioembolic source demonstrated a 1.1×0.7 cm mitral valve vegetation. As multiple blood cultures were sterile and patient lacked clinical signs of infection, an underlying malignancy was suspected. CT abdomen demonstrated a dilated pancreatic duct, MRI showed a 2.8×2.2 cm pancreatic head mass. Endoscopic biopsy of the mass revealed pancreatic adenocarcinoma. Other than NBTE, there were no other clinical or laboratory findings to clearly suggest pancreatic cancer. Thus, incidental discovery of this mitral valve vegetation led to the diagnosis of pancreatic malignancy.


  • Contributors ES, EAR and EB contributed to clinical management. SS: attending physician managing the patient. All authors contributed to the writing and editing the manuscript and completing the submission process.

  • 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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