Background Marantic endocarditis and Trousseau’s syndrome are historically linked with pancreatic cancer. The patient had catastrophic embolic events which caused multi organ infarct due to underlying advanced pancreatic cancer. Doctors should be aware of early signs and symptoms of pancreatic cancer and conduct necessary clinical assessment and investigations which can prevent any severe complications. Case presentation A middle-aged healthy gentleman who presented with left sided weakness, slurred speech, left sided sensory neglect, mild headache and fever. CT head showed acute right sided temporal ischaemic changes with subsequent MRI head showed multiple infarcts in the brain. Transoesophageal echocardiogram reported possible MV vegetation. MRI of the liver was done due to deranged LFTs which showed multiple liver metastasis with primary mass in the tail of pancreas. Left leg ultrasound doppler showed a large left leg deep vein thrombosis involving femoral vein as he complained of left leg pain for 2 months and went to GP with right leg pain 3 months ago which was treated as right ankle sprain. The clinical events explained that most likely he developed Trousseau's syndrome 3 months ago and the embolic phenomena was due to rare Marantic endocarditis (Non-bacterial thrombotic endocarditis) secondary to pancreatic cancer. Ultrasound guided biopsy of liver metastasis was planned, but sadly the patient passed away the next day. Conclusion The diagnosis of early pancreatic cancer with imaging poses a challenge sometimes, therefore the pancreatic protocol of CT or MRI is the first line investigation. Moreover, the cause of unprovoked thrombo-embolism should be investigated to rule out any underlying malignancy.

Keywords: Pancreatic cancer, Marantic Endocarditis, Trousseau's syndrome