Myocardial infarction due to non-bacterial thrombotic endocarditis in a patient with oligodendroglioma: an unusual presentation and diagnostic challenge-a case report.

Background: Non-bacterial thrombotic endocarditis (NBTE) represents a manifestation of thrombotic endocarditis characterized by the formation of thrombus on the heart valve leaflet. While neurological events are the most frequent initial presentation of NBTE, myocardial infarction also stands out as a major clinical manifestation among NBTE patients.

Case Summary: A 61-year-old female with no history of cardiovascular disease or episodes of chest pain suffered a left main trunk ST-segment elevation myocardial infarction (STEMI) after craniotomy for the treatment of oligodendroglioma. A comprehensive diagnostic workup, including coronary angiography, revealed no evidence of embolism. However, autopsy findings, in conjunction with cardiac ultrasound, contrast-enhanced computed tomography, and transoesophageal echocardiogram results, conclusively demonstrated that NBTE had obstructed the left main trunk of the coronary artery, leading to STEMI.

Discussion: Non-bacterial thrombotic endocarditis should be strongly considered in the differential diagnosis for patients presenting with acute cerebrovascular events or coronary ischaemia, especially in the presence of predisposing factors such as a history of malignancy, systemic inflammation, or embolic phenomena of indeterminate origin. This consideration is critical for the timely identification and management of NBTE, ultimately mitigating the risk of severe complications and optimizing patient outcomes.