Korean Circ J.  2016 May;46(3):425-428. 10.4070/kcj.2016.46.3.425.

Non-Bacterial Thrombotic Endocarditis in a Patient with Rheumatoid Arthritis

• Choi JH
• Park JE
• Kim JY
• Kang T

• KMID: 2344458
• DOI: http://doi.org/10.4070/kcj.2016.46.3.425

Abstract

Rheumatoid arthritis (RA) is frequently associated with various extra-joint complications. Although rare, thromboembolic complications are associated with high morbidity and mortality. We experienced a very rare case of nonbacterial thrombotic endocarditis (NBTE) and subsequent embolic stroke in a patient with RA. A 72-year-old male with a 15-year history of RA suddenly developed neurologic symptoms of vomiting and dizziness. Brain magnetic resonance imaging revealed recently developed multiple cerebellar and cerebral lacunar infarctions. Echocardiography showed a pulsating mitral valve vegetation involving the posterior cusp of the mitral valve leaflet, which was confirmed as NBTE. Immediate anti-coagulation therapy was started. The NBTE lesion disappeared in follow-up echocardiography after 4 weeks of anti-coagulation treatment.

Keyword

Endocarditis, non-infective; Arthritis, rheumatoid; Mitral valve

MeSH Terms

Aged
Arthritis, Rheumatoid*
Brain
Dizziness
Echocardiography
Endocarditis
Endocarditis, Non-Infective*
Follow-Up Studies
Humans
Magnetic Resonance Imaging
Male
Mitral Valve
Mortality
Neurologic Manifestations
Stroke
Stroke, Lacunar
Vomiting

Figure

• 

  Fig. 1 Mitral valve vegetation. (A, B) Transthoracic echocardiography showing a 0.27×2.27 cm sized characteristic hyperechoic mass-like nodular lesion (NBTE, arrow) attached to the posterior cusp of the mitral valve. This lesion had a stem connecting the mass to the mitral valve, causing the lesion to show a to and fro motion in accordance with the cardiac cycle. (C, D) After 4 weeks of anticoagulation therapy, the NBTE lesion disappeared almost completely on echocardiography. NBTE: nonbacterial thrombotic endocarditis.

• 

  Fig. 2 Brain magnetic resonance image. The arrow indicated the location of multifocal cerebellar (A: diffusion weighted image, B: diffusion weighted image) and cerebral infarctions (C: T2 weighted image).

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