CURRENT ISSUE

We describe the case of a 21-year-old patient presenting with marantic endocarditis of the aortic valve occurring in the context of underlying metastatic fibrolamellar hepatocellular carcinoma. The patient was admitted due to a pulmonary embolism complicating deep vein thrombosis in the right lower limb. Upon admission, the patient was hemodynamically stable and afebrile, with a poor general condition. Physical examination revealed a painful swelling in the right lower limb extending up to the thigh, hepatomegaly suggestive of a tumor, and moderate ascites. Cardiac auscultation did not reveal any murmurs or abnormal sounds. Laboratory tests showed a non-specific inflammatory syndrome, and blood cultures were negative. The electrocardiogram indicated regular sinus tachycardia. Echocardiography revealed a mobile, hyperechoic mass located on the ventricular aspect of the aortic valve, without regurgitation or stenosis. The patient was started on heparin therapy. Unfortunately, the patient passed away at home two weeks later, and no autopsy was performed.

Sodium-glucose cotransporter-2 inhibitors (SGLT2-i) have been effective for heart failure (HF), chronic kidney disease (CKD), and type 2 diabetes (T2D). Among SGLT2-i, empagliflozin and dapagliflozin were compared for clinical effect, with empagliflozin showing a lower composite of all-cause mortality or hospitalization with a hazard ratio (HR) of 0.90. In the EMPA-ELDERLY clinical trial, empagliflozin demonstrated better HbA1c reduction and weight reduction without affecting muscle strength or mass in elderly patients with T2D. The American College of Physicians (ACP) published “Newer Pharmacologic Treatments in Adults with Type 2 Diabetes” in April 2024. The potential mechanisms for the anti-inflammatory effects of SGLT2-i will be clarified in the future.