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Vol.59 No.3 contents | Japanese/English |
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- Case Report -
A Case of Nonbacterial Thrombotic Endocarditis with EGFR-mutated Lung Cancer Treated with Afatinib
Yuki Kawamoto1, Kana Hayakawa1, Yoshio Nakano1, Takahiro Hayakawa1, Takayuki Ota1, Keizou Kimura21Department of Internal Medicine, 2Division of Cardiology, Department of Internal Medicine, Kinan Hospital, Japan
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.
key words: Lung cancer, Nonbacterial thrombotic endocarditis, Molecular targeted drugs, Afatinib
Received: November 15, 2018
Accepted: February 26, 2019
JJLC 59 (3): 248-253, 2019
