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Nonbacterial thrombotic endocarditis (NBTE) is a rare condition characterized by the development of sterile thrombotic vegetation (s) on cardiac valves that is most commonly associated with advanced malignancy and chronic inflammatory diseases including systemic lupus erythematosus and antiphospholipid antibody syndrome (APLAS). 1 Nonbacterial thrombotic endocarditis is most often found postmortem, with rates in autopsy series of approximately 1.2%. 2 In a study of 48 patients with NBTE, the condition was more prevalent in women. 3 The exact pathogenesis of the disease is still not known; however, endothelial injury in the setting of hypercoagulable states, hypoxia, immune complexes, and carcinomatosis is thought to be associated with the initiation of the disease. 4 Nonbacterial thrombotic endocarditis differs from culture-negative endocarditis, which has infectious origins based on clinical description …