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Infective endocarditis with co-existent acalculous cholecystitis: a rare but important association

Matthew I Jones1, Daniel Vawdrey, Richard P W Cowell

  • 1Department of Cardiology, Wrexham Maelor Hospital, Offa, Wrexham, UK. matthewianjones@gmail.com

BMJ Case Reports
|June 16, 2012
PubMed

Insights

A healthy male with abdominal pain developed acute pulmonary edema and a new heart murmur, rapidly progressing to cardiac arrest. Postmortem revealed bacterial endocarditis causing aortic valve rupture and acalculous cholecystitis.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Gastroenterology

Background:

  • Acalculous cholecystitis can present with non-specific symptoms.
  • Infective endocarditis is a serious condition with varied clinical manifestations.

Observation:

  • A retired male presented with fever, rigors, and right upper quadrant pain, initially diagnosed with acalculous cholecystitis.
  • Rapid clinical deterioration occurred, with new signs of acute pulmonary edema and a cardiac murmur.

Findings:

  • Transthoracic echocardiography identified severe aortic regurgitation, leading to a presumptive diagnosis of infective endocarditis.
  • Postmortem examination confirmed aortic valve cusp rupture due to bacterial endocarditis and acute acalculous cholecystitis.

Implications:

  • This case highlights the critical importance of considering infective endocarditis in patients with unexplained deterioration and abdominal symptoms.
  • Prompt diagnosis and management of infective endocarditis are crucial to prevent severe cardiac complications and mortality.
  • The coexistence of acalculous cholecystitis and infective endocarditis underscores the complex interplay of conditions that can arise in critically ill patients.

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