[Escherichia coli's endocarditis in a prosthetic aortic valve - diagnostic and therapeutic particularities]

Escherichia coli endocarditis is a rare condition, even though bacteriemia by such agent is common. The infection, normally from a urinary origin, may, in fact, progress without major hemodynamic disturbance and minimal symptoms, regardless its ability of destruction of heart's valvular apparatus. We present a case report of a 68-year-old man, with a history of aortic valvular mechanic prosthesis, dyslipidemia and hypertension, admitted at the emergency room with refractory fever and urinary tract symptoms. On the hypothesis of endocarditis, he was submitted to transesofagic echocardiography that suggested a prosthetic vegetation, without hemodynamic dysfunction. E. coli was cultured from the blood soon after, and antibiotics adapted according to sensibility testing. Nevertheless, the patient deteriorated, both clinically and echocardiographically, with development of periprosthesis abscess, detachment of the prosthesis and extension of the infection to other valves, with hemodynamic dysfunction. The infection was only restrained with a surgical approach, which reflects the importance of this therapeutic weapon in these situations, including the correct timing.