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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 …
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.