Rattibha

Sthanu

7 Tweets 10 reads Sep 30, 2022

A previously healthy 48-year-old man 👉acute onset of pain in both flanks
👉 during the preceding 6 months he had had an unintentional weight loss of approximately 5 kg

👉numerous splinter hemorrhages were observed on the fingernails of both hands (Panel A).
👉no cardiac murmur was heard
👉 the abdomen was tender and the spleen was palpable
👉 blood cultures were drawn
👉 antibiotic trt was initiated for suspected bacterial endocarditis.

👉 TEE showed mobile echogenic foci on the tricuspid and mitral valves
👉 CT abdomen revealed a mass in the neck of the pancreas, multiple liver lesions, and multiple hypodensities in the spleen and kidneys
👉 consistent with infarcts (Panel B)

👉 biopsy specimen of a liver lesion revealed pancreatic adenocarcinoma
👉 blood cultures and serologic tests for organisms known to cause culture-negative infe endocarditis were negative
♦️
Dx nonbacterial thrombotic endocarditis associated with metastatic pancreatic cancer

👉anticoagulation therapy with low-molecular-weight heparin was initiated, as was chemotherapy
👉 flank pain, peripheral stigmata of endocarditis, cardiac-valve thrombi resolved
♦️
However, 7 months after diagnosis, he died from complications of progressive pancreatic cancer