A particular case of infectious endocarditis

Introduction: Infectious endocarditis (IE) is a disease caused by bacteria from other parts of the body or in-troduced during medical maneuvers. IE it is among the most life-threatening infections. Injured or artificial heart valves, congenital diseases or other heart defects or cardiac/extracardiac devices are the most commonly reported risk factors for the development of this disease. Among the etiological agents, the most common pathogens are Staphylococcus aureus and germs from the group Streptococcus viridans, belonging to the nor-mal oral, cutaneous, respiratory and gastrointestinal tract flora, which cause about 50-60% of IE cases, as well as enterococci.

Objective: We will present the particularities and complications with cardiovascular and systemic impact of a patient with infectious endocarditis.

Case presentation: We present the case of a 53-year-old patient, male, diabetic, suffering from alchoolism, with ventriculoperitoneal shunt (2014) who was admited for progressivly agravated dyspnea for 1 month, febrile episode at home, cough, weight loss, fatigue. About 3 months ago, the patient underwent a tooth extraction. The suspicion of infectious endocarditis is raised, which is confirmed by clinical, biological tests (positive blood cultures with Streptococcus Gallolyticus), echocardiographic (endocardial damage of aortic valve with vegetations, severe regurgitation secondary to le-aflet rupture) and thoracic CT scan with inflammation of the aortic wall with fluid accumulation around ascending aorta. In conditions of sepsis with low cardiac output, the patient suffered multiple organ dysfunction syndrome. The patient associated biventricular dys-function, severe tricuspid regurgitation, probable PAH, moderate mitral regurgitation. The evolution was slowly favorable both clinically, under antibiotic therapy with Meropenem, Linezolid, Doxycycline (afebrile patient, eupneic, with arterial blood pressure values maintained within normal limits), biological (decreased leukocytosis, inflammatory markers, negative blood cultures, values for creatinine and transaminases normalized) as well as aortic valve vegetations slightly diminished in size, decreased infiltration of the ascending aortic wall and periaortic fluid. Because the patient was in anasarca, pleural drainage was performed – cells without appearance of malignancy. The ventriculoperitoneal shunt remained permeable.

Conclusions: The patient showed a slowly favorable evolution, and will perform surgery aortic valve re-placement, with reevaluation of the ascending aorta and aortic cross in terms of inflamed tissue, with prior remediation of the surces of infection. We consider the presence of the ventriculoperitoneal shunt a pos-sible source of cantonment for the infection. Although S. Gallolitycus is frequently associated with colonic neoplasm, the patient was screened negative for this condition, but he is a patient that suffers from alchool use disorder, with compromised immune system. The presence of inflammation of the aortic duct is a rare association of S. Gallolitycus infection, being most likely secondary to the local cause of infectious and in-flammatory valve damage.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)