Infective endocarditis in a heart transplant recipient

A 38-year-old man underwent orthotopic heart transplantation because of heart failure caused by ischemic heart disease. Three months after the operation cholestatic jaundice related to azathioprine hepatotoxicity developed, necessitating supplementation of cyclosporine immunosuppression with prednisolone. Seven months after heart transplantation he had a septic right femoral embolus and, by transesophageal echocardiography, was found to have a vegetation on the anterior leaflet of the mitral valve. Treatment with appropriate antibiotics resulted in complete resolution of symptoms and healing of the vegetation. Six months after the episode he remains free of symptoms and has normal heart function.