Key result
Induction chemotherapy and mitral valve replacement resolve NBTE-induced cardiogenic shock in acute promyelocytic leukemia.
Why the study?
Nonbacterial thrombotic endocarditis is rarely associated with leukemia, with fewer than 5 cases reported in acute promyelocytic leukemia.
Case Report (n=1)
This case highlights that nonbacterial thrombotic endocarditis can rarely present as a paraneoplastic manifestation of acute promyelocytic leukemia, requiring coordinated oncologic and surgical cardiac care.
BACKGROUND: Nonbacterial thrombotic endocarditis (NBTE) is a noninflammatory endocarditis that occurs in hypercoagulable states. Acute promyelocytic leukemia (APL) is an aggressive form of acute leukemia associated with significant coagulopathy. CASE SUMMARY: A 45-year-old woman with new pulmonary emboli and progressive heart failure developed pancytopenia, leading to diagnosis of APL and cardiogenic shock secondary to NBTE of the mitral valve. APL was treated with induction chemotherapy, alongside inotropic support for cardiogenic shock. After cancer remission, she underwent mitral valve replacement, resolving the cardiogenic shock. DISCUSSION: NBTE is a recognized complication of solid malignancy but is rarely associated with leukemia. Fewer than 5 cases have been reported in APL. This case highlights 2 critical complications of each disease process: cardiogenic shock and disseminated intravascular coagulation. TAKE-HOME MESSAGES: APL and NBTE can present as oncologic and cardiac emergencies. Co-managing these conditions requires a multidisciplinary approach integrating specialized care in both cardiology and oncology.
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Fradin et al. (2025) conducted a case report in Acute promyelocytic leukemia and nonbacterial thrombotic endocarditis (n=1). Induction chemotherapy and mitral valve replacement was evaluated on Cancer remission and resolution of cardiogenic shock. Induction chemotherapy followed by mitral valve replacement successfully treated a 45-year-old woman presenting with acute promyelocytic leukemia and cardiogenic shock secondary to NBTE.
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