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Osteoarticular infection complicating enterococcal endocarditis

Nicholas E Vlahakis1, Zelalem Temesgen, Elie F Berbari

  • 1Division of Pulmonary and Critical Care Medicine and Internal Medicine, Mayo Clinic, Rochester, Minn 55905, USA. vlahakis.nicholas@mayo.edu

Mayo Clinic Proceedings
|May 15, 2003
PubMed

Insights

This study highlights a rare case of disk space infection in a patient with enterococcal endocarditis. Early recognition and treatment of infectious osteoarticular complications are crucial for better patient outcomes.

Area of Science:

  • Infectious Diseases
  • Cardiology
  • Orthopedics

Background:

  • Musculoskeletal complaints are common in infective endocarditis, but osteoarticular complications are infrequently diagnosed.
  • Enterococcal infection is the third most common cause of infective endocarditis, yet osteoarticular complications are rare in these cases.

Observation:

  • A case of disk space infection in a patient with Enterococcus faecalis endocarditis is presented.
  • Blood cultures and L3-4 aspirate confirmed Enterococcus faecalis.
  • Transthoracic echocardiography revealed a large vegetation on the posterior mitral valve leaflet.

Findings:

  • The osteoarticular infection resolved with antimicrobial treatment.
  • Worsening heart failure necessitated mitral valve replacement surgery.
  • A literature review identified 13 additional cases of enterococcal endocarditis with osteoarticular complications between 1966 and 1998.

Implications:

  • This case underscores the rare but significant risk of osteoarticular infection in enterococcal endocarditis.
  • Early diagnosis and prompt treatment of these complications are essential.
  • Multidisciplinary management involving infectious disease, cardiology, and orthopedic specialists may be required.

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