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A 58-year-old smoker with three weeks of fever, soaking sweats, and negative blood cultures.

Pictures showing a splinter hemorrhage (upper right), toe necrosis due to emboli (upper left) and a marantic lesion on the mitral valve (arrow, lower left). (case report published in the NEJM).

MARANTIC ENDOCARDITIS (ME) is due to bland (uninfected) vegetations on the heart valves of persons with malignancy, systemic lupus erythematosus, the antiphospholipid syndrome, or other diseases that manifest  hypercoagulability. Clinically, it resembles bacterial endocarditis.
A related syndrome, nonbacterial thrombotic endocarditis (NBTE), is characterized by the deposition of platelet-fibrin thrombi on valvular endothelium damaged by high-velocity blood jets. Rheumatic heart disease, mitral valve prolapse, degenerative valvular disease, and congenital heart disease are the most common associated cardiac conditions. Treatment includes anticoagulation and appropriate therapy of the malignancy, if present.