Nonbacterial thrombotic endocarditis (NBTE, marantic endocarditis) is characterized by sterile vegetations at the line of valve closure. Which clinical setting is it MOST associated with?
- A Mucinous adenocarcinoma of the pancreas (Trousseau syndrome) ✓
- B Acute rheumatic fever
- C Intravenous drug use
- D Systemic lupus erythematosus
Explanation
NBTE (marantic endocarditis) is most frequently associated with advanced malignancies, especially mucinous pancreatic adenocarcinoma and mucin-secreting GI or lung carcinomas. Tumor-derived procoagulants and mucin activate coagulation and cause a hypercoagulable state (Trousseau syndrome), promoting fibrin-platelet vegetations on morphologically normal valves without inflammation. These emboli cause strokes and systemic emboli. Acute rheumatic fever causes 'MacCallum's patch' and valvulitis, not NBTE. IV drug use causes right-sided infective endocarditis. Libman-Sacks endocarditis occurs in SLE (both surfaces of the valve).
Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.