[Proceedings could be dangerous! An endocarditis clinical case]

Area of Science:

• Cardiology
• Infectious Diseases
• Gastroenterology

Background:

• Infective endocarditis (IE) is a serious infection that can arise after invasive procedures.
• Current international guidelines for IE prophylaxis require clarification regarding specific high-risk scenarios.
• Transrectal procedures, including proctosigmoidoscopy, pose a potential risk for IE development.

Observation:

• A 55-year-old male with a history of aortic/pulmonary valvuloplasty and hemorrhoids developed Streptococcus Viridans IE post-proctosigmoidoscopy.
• The patient experienced severe complications, including pleuritis and pneumonia, necessitating a 7-month hospitalization.
• This case highlights the potential severity of IE following transrectal interventions.

Findings:

• The clinical case underscores the need for a multidisciplinary approach involving cardiologists, general practitioners, and procedural physicians.
• Existing guidelines (Level C evidence) may not fully address all potential invasive examinations and treatments relevant to IE prevention.
• The findings suggest that antibiotic prophylaxis could be beneficial for high-risk IE patients with hemorrhoids prior to transrectal procedures.

Implications:

• Clarification of international guidelines is needed to better define IE prophylaxis strategies for specific patient populations and procedures.
• Consideration of antibiotic prophylaxis in high-risk individuals with hemorrhoids undergoing transrectal procedures may reduce IE incidence.
• Enhanced collaboration among medical specialists is crucial for managing complex cases of infective endocarditis.