Infectious endocarditis associated with spondilodiscitis: a diagnostic and therapy challenge

Introduction: Infectious endocarditis is a pathology with an incidence level of less than 10 in 100.000, with clinical and paraclinical repercussions that are both lo-cal and systemic, with high complication and mortality rates, as diagnosis and treatment are often difficult.
Case presentation: We present a forty-seven-year-old patient, with no recorded cardiovascular precedents. In September 2017, she was diagnosed with an episode of dorso-lumbar spondyloscitis, treated empirically with antibiotics (more specifically, teicoplanin) for three weeks in January 2018. The patient was then admitted into the cardiology ward with resting heart failure and rapid palpitations, all of which abruptly started in Mar-ch 2018. Upon admission, she was intensely sympto-matic, afebrile, with an objective examination revealing tachycardic cardiac sounds, fourth degree systolic mi-tral regurgitation murmur, as well as pulmonary and peripheral stasis. The ECG examination revealed an atrial flutter rhythm of 2:1, with a ventricular rate of 140 per minute, and the initial echocardiogram evi-dentiated slightly dilated left cardiac chambers with a minor LV dysfunction and significant valve regurgi-tation on the aortic, mitral and tricuspid levels, with possible vegetations attached to the aortic and mitral valves, hepatic stasis and bilateral pleural collections. Biologically, she suffered from: hepatocytolysis, cho-lestasis and elevated NT-proBNP, with no inflamma-tory syndrome. Her trans-esophageal echocardiogram confirmed the presence of vegetations plus mitral and aortic valve damage, and raised suspicions of infectio-us endocarditis of the aortic and mitral valves, perhaps combined with a puncture of the anterior mitral valve. A set of blood culture tests were done on special growth media and an empirical antibiotic treatment was star-ted, using Ampicillin and Gentamicin. Later, the atri-al flutter was electrically converted to a sinus rhythm, furthering her clinical compensation and resulting in a slowly favorable evolution. The results of the blood culture tests were negative. Despite the symptomatic improvements, significant valve regurgitation was still occurring, which led to the patient undergoing surgery for mitral and aortic valve replacement, during which endocarditic valve damage was confirmed.
The particular nature of this case stems from the lack of an IE diagnosis during the acute phase and the remis-sion of the infectious process, which can be attributed to an empirical antibiotics treatment to which the pati-ent was subjected eight months prior, in order to cure a spondyloscitis. Twenty-six percent of the time, this ill-ness is associated with infectious endocarditis, possibly representing a starting point for this case’s bacteriemia as well. The later clinical situation was generated by the repercussions of valve and tissue destruction, brought on by the endocardial infection

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)