Rapid Embolic Event Chain: An Unusual Presentation of Marantic Endocarditis

Nonbacterial thrombotic endocarditis (NBTE), formerly known as marantic endocarditis, is characterized by sterile, noninfectious vegetations typically associated with hypercoagulable states, most commonly malignancies. Despite its noninfectious nature, NBTE can lead to serious complications similar to those seen in infectious endocarditis, including stroke, venous thromboembolism, splenic or hepatic infarcts, and acute intestinal ischemia. We present an unusual case involving a cascade of rapid embolic events in a patient newly diagnosed with metastatic lung cancer. The patient developed critical limb ischemia requiring bilateral below-knee amputation, with an echocardiogram revealing mitral valve vegetations. Postoperatively, the patient suffered an acute stroke and acute coronary syndrome, ultimately resulting in death. This case underscores the importance of early recognition and intervention in NBTE to prevent severe thromboembolic complications.