A Case of Nonbacterial Thrombotic Endocarditis with EGFR-mutated Lung Cancer Treated with Afatinib

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  • アファチニブが有効であった非感染性心内膜炎合併EGFR遺伝子変異陽性肺癌の1例

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<p>Background. Nonbacterial thrombotic endocarditis is known as Trousseau syndrome. However, it is often diagnosed only after the onset of cerebral infarction because of the difficulty of its diagnosis. Furthermore, no treatment has yet been established, making its prognosis extremely poor. Case. A 68-year-old man complaining of low back pain was admitted to our hospital under suspicion of bone metastasis to the lumbar vertebrae. He was diagnosed with primary lung adenocarcinoma (cT1bN2M1b, cStage IVB, EGFR-positive), and afatinib was initiated. He developed a fever after starting afatinib, and transthoracic echocardiography was performed. Aortic valve vegetation was found, but no antibiotics or anticoagulation therapy was started. The aortic valve vegetation disappeared 10 days after he first developed the fever, and all blood cultures were negative. The diagnosis was lung cancer with nonbacterial thrombotic endocarditis. The lung cancer was markedly diminished by chemotherapy, and he showed no recurrence of thrombosis. Conclusion. We herein report a rare case in which nonbacterial thrombotic endocarditis was diagnosed before cerebral infarction and cured without using anticoagulation therapy. It is important to start chemotherapy against cancer as soon as possible.</p>

Journal

  • Haigan

    Haigan 59 (3), 248-253, 2019-06-20

    The Japan Lung Cancer Society

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