Marantic Endocarditis as a Rare Complication of Metastatic Pancreatic Adenocarcinoma: Case Report and Literature Review

Hypercoagulability is a common complication in pancreatic cancer, and nonbacterial thrombotic endocarditis (NBTE), or marantic endocarditis, is a frequently underdiagnosed manifestation of this prothrombotic state. It can lead to significant morbidity, especially through recurrent ischemic cerebrovascular events. This case report discusses a 62-year-old male with pancreatic adenocarcinoma and liver metastases who initially presented with deep venous thrombosis (DVT). He was treated with palliative chemotherapy, but before his second cycle, he developed neurological symptoms, which were diagnosed as ischemic strokes. Further investigation revealed nonbacterial thrombotic endocarditis (NBTE), confirmed by the presence of a vegetation on the mitral valve, despite negative blood cultures. A review of recent literature highlighted that NBTE, often linked to pancreatic cancer, commonly presents with ischemic strokes and thrombotic events. It emphasizes the importance of early detection of NBTE in cancer patients, as neurological symptoms can mask the underlying cancer, and timely multidisciplinary management is crucial for improving outcomes.