Non-bacterial thrombotic endocarditis in a patient with high-grade serous ovarian carcinoma: diagnostic challenges and management insights

Non-bacterial thrombotic endocarditis (NBTE) is characterised by sterile vegetations on heart valves and often emerges in hypercoagulable states like malignancy. It is frequently underdiagnosed and only comes to light during postmortem examination. Early diagnosis and treatment with anticoagulation can help lower mortality. We present a case of a woman in her 60s with marantic endocarditis, secondary to ovarian malignancy. She presented with a 4 week history of headache, confusion and abdominal discomfort. Examination revealed cyanosis, splinter haemorrhages and abdominal tenderness. Echocardiogram showed impaired left ventricular function and suspicion of a small vegetation at the tip of the anterior mitral valve. Further investigation revealed multiple cerebellar infarcts, pulmonary embolism, splenic infarct, ascites and a pelvic mass. A biopsy of the pelvic mass and analysis of ascitic fluid was consistent with high-grade serous carcinoma of tubo-ovarian origin. Following discussion at the gynaecology multidisciplinary team meeting, she was scheduled for chemotherapy treatment.