Nonbacterial thrombotic endocarditis after lung transplantation

Bacteria-free verrucae has been recognized as a condition associated with several clinical conditions such as bone marrow transplantation, malignant tumors, autoimmune disorders, and acquired immunodeficiency syndrome, but it has not been reported in relation to lung transplantation. We report the case of a patient who underwent bilateral lung transplant and died 3 days later. Histologic examination revealed, among other lesions, the presence of nonbacterial thrombotic endocarditis in the right atrium and mitral and tricuspid valves that was not present in the preoperative echocardiographic studies. Even with transesophageal echocardiography, a reliable detection of vegetations may not be possible. Hypoxigenic pulmonary states developed in the course of lung transplant could be the factor that triggers the interaction between the coagulation system, platelets, and endothelial cells that induce the formation of bacteria-free verrucae.