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Inicio Revista Española de Anestesiología y Reanimación (English Edition) Marantic endocarditis
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Vol. 67. Issue 4.
Pages 208-211 (April 2020)
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Vol. 67. Issue 4.
Pages 208-211 (April 2020)
Case report
Marantic endocarditis
Endocarditis marántica
Visits
17
B. Sánchez Quirós
Corresponding author
Belensq93@gmail.com

Corresponding author.
, N. Ruiz López, R. López Herrero, C. Bartolomé Bartolomé
Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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Abstract

Marantic endocarditis is characterised by the presence of sterile vegetations in the heart valves, and is associated with hypercoagulability states (cancer, autoimmune diseases, HIV). Its main complications are stroke, pulmonary thromboembolism, acute intestinal ischaemia and splenic, renal and hepatic infarcts. We present the case of a 57-year-old patient with a history of uterine neoplasia. She went to the emergency department due to sudden loss of strength in the left side of the body. A computed tomography (CT) scan showed right ischaemic stroke, and she underwent endovascular reperfusion and thrombectomy. Four days later, she suffered acute respiratory failure, with angio-CT showing pulmonary thromboembolism. Later, paroxysmal atrial fibrillation and distal ischaemia in the second toe of the left foot appeared. She was diagnosed with marantic endocarditis by means of transesophageal echocardiography, and died 72h later due to multiorgan failure. Early diagnosis and treatment with anticoagulation can reduce the mortality of this disease, since it is underdiagnosed, and often only comes to light during postmortem examination.

Keywords:
Marantic endocarditis
Nonbacterial thrombotic endocarditis
Anticoagulation
Diagnosis
Treatment
Transesophageal echocardiography
Resumen

La endocarditis marántica se caracteriza por la presencia de vegetaciones estériles en las válvulas cardiacas. Se asocia a estados de hipercoagulabilidad (cáncer, enfermedades autoinmunes, VIH). El ictus, el tromboembolismo pulmonar, la isquemia intestinal aguda y los infartos esplénicos, renales y hepáticos son sus principales manifestaciones. Presentamos el caso de una paciente de 57 años, con antecedentes de neoplasia uterina intervenida 5 años antes, que acudió al servicio de Urgencias por pérdida brusca de fuerza en hemicuerpo izquierdo. La tomografía axial computarizada mostró un ictus isquémico derecho y se sometió a reperfusión endovascular y trombectomía 3h después del inicio de la clínica. A los 4 días sufrió insuficiencia respiratoria aguda, con angio-TAC compatible con tromboembolismo pulmonar. Después aparecieron fibrilación auricular paroxística e isquemia distal en el segundo dedo del pie izquierdo. Fue diagnosticada de endocarditis marántica por ecocardiograma transesofágico y falleció 72h después por fracaso multiorgánico. El diagnóstico y el tratamiento precoces con anticoagulación pueden disminuir la mortalidad de esta enfermedad, que suele ser infradiagnosticada, con un alto porcentaje de diagnóstico post mortem.

Palabras clave:
Endocarditis marántica
Endocarditis trombótica no bacteriana
Anticoagulación
Diagnóstico
Tratamiento
Ecocardiograma transesofágico
Endocarditis tumoral

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