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Non-bacterial thrombotic endocarditis: manifestations and diagnosis in the age of echocardiography
  1. Matthew C Langston1,
  2. Chad J Zack2,
  3. Erin Amanda Fender1
  1. 1 Cardiology, Christiana Care Health Services Inc, Wilmington, Delaware, USA
  2. 2 Cardiology, Penn State College of Medicine, Hershey, Pennsylvania, USA
  1. Correspondence to Dr Erin Amanda Fender, Cardiology, Christiana Care Health Services Inc, Wilmington, Delaware, USA; erin.fender{at}

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Sterile vegetations of the cardiac valves were first identified in 1888 by Zeigler, with case reports described eponymously in 1924 by Libman and Sacks.1 2 These and subsequent early accounts identified an association between non-infectious endocarditis and a variety of diseases, specifically malignancy and rheumatological conditions such as systemic lupus erythematosus (SLE) and antiphospholipid antibody syndrome (AAS). Autopsy cases predominated the early literature; however, after the advent of echocardiography, many case series relied on non-invasive diagnosis (table 1).3 4 These studies found a strong association with cancers, with a higher prevalence and greater mortality in patients with metastatic disease. Up to 31 per cent of cases are in fact culture-negative endocarditis rather than non-bacterial thrombotic endocarditis (NBTE). Therefore, a diagnosis of NBTE requires obtaining extended blood cultures to ensure infection is fully excluded.5 Currently, the …

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  • Contributors MCL, CJZ and EAF were responsible for the drafting and critical revision of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

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