RT Journal Article SR Electronic T1 Non-bacterial thrombotic endocarditis and metastatic lung adenocarcinoma JF BMJ Case Reports JO BMJ Case Reports FD BMJ Publishing Group Ltd SP e242948 DO 10.1136/bcr-2021-242948 VO 14 IS 7 A1 Yi Zhou A1 Yucai Yee A1 Yan Qin YR 2021 UL http://casereports.bmj.com/content/14/7/e242948.abstract AB A 69-year-old Chinese man presented with exertional dyspnoea and subjective left upper limb weakness. Initial clinical impressions were community-acquired pneumonia and cerebrovascular accident. Further imaging studies revealed an incidental mitral valve vegetation and left lung upper lobe nodule likely a lung malignancy with possible lymphangitis carcinomatosis. Appropriate empirical antibiotic treatment for infective endocarditis was instituted early in admission, but multiple blood cultures were negative. 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.