Recurrent nonbacterial thrombotic endocarditis and stroke on anticoagulation

Abstract

We present a rare case of recurrent nonbacterial thrombotic endocarditis (NBTE) and stroke despite anticoagulation. A 48-year-old man with history of antiphospholipid syndrome, prior nonbacterial aortic valve endocarditis status post valve replacement and prior stroke was found to have acute ischemic stroke while on apixaban and nonbacterial thrombotic endocarditis of mitral valve. This was initially managed conservatively with therapeutic dose of enoxaparin, but the patient later underwent mitral valve replacement. Unfortunately, the patient later passed away with hemorrhagic stroke while on enoxaparin.

Recurrent Nonbacterial Thrombotic Endocarditis and Primary Antiphospholipid Antibody Syndrome

“…The risk of progression appears to be associated with higher titres of anti-cardiolipin antibodies and positive lupus anticoagulants [ 5 ]. Our case is of interest as it is one of a few describing recurrence of NBTE after surgical resection requiring a re-do sternotomy and valve replacement [ 6 ]. Notably, the resurgent disease process was florid with unusually abundant and corpulent vegetation.…”

A Cryptogenic Stroke Associated With Infective Endocarditis and Antiphospholipid Antibody Syndrome: Case Report and Literature Review

“…Native valve disease, such as a bicuspid aortic valve (BAV) vegetation-induced septic embolic cerebrovascular accident, is even less common ( 2 ). Although rare, antiphospholipid antibody syndrome (APS) can develop into cardiac valvular lesions and produce intracardiac thrombi ( 3 , 4 ). While cardioembolic stroke is often a severe condition and the etiology is various, diagnosis is challenging for physicians, particularly given the time pressure ( 5 ).…”