Non-Infective Endocarditis (NBTE / Marantic Endocarditis) Non-infective endocarditis is also known as: Non-bacterial thrombotic endocarditis (NBTE), Aseptic endocarditis, Libman-Sacks endocarditis (refers specifically to NBTE in patients with SLE and APLS), Verrucous endocarditis, Marantic endocarditis Characteristics: • Hallmark = deposition of sterile fibrin and platelets on the surface of valve leaflet • Vegetations may be microscopic or large in size with clustered appearance • May occur anywhere on endocardial surface • Predilection for left-sided heart valves • Lack of inflammation at vegetation base makes lesions more friable and likely to embolize • Cannot differentiate infective vs non-infective vegetation on echo • Histopathology: degenerating platelets interwoven with fibrin strands, granulatomous tissue, fibrotic foci. Inflammatory cells and microorganisms absent How can we differentiate NBTE from infective IE? No pathognomonic signs/symptoms or echo features that are specific to NBTE, and diagnosis can only be confirmed with demonstration of platelet thrombi on histologic exam. So high index of clinical suspicion is required for diagnosis! - Infectious Diseases Fellows Network @ID_fellows #NonInfective #Endocarditis #NBTE #Marantic #diagnosis #pathophysiology
