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Actinobacillus endocarditis associated with hypertrophic cardiomyopathy.
Vanda Cristina Jorge1, Ana Carolina Araújo, Ana Grilo
1Department 2, Curry Cabral's Hospital, Lisbon, Portugal. vandacristinajorge@gmail.com
BMJ Case Reports
|August 15, 2012
Summary
Infective endocarditis caused by Actinobacillus actinomycetemcomitans is rare but serious. This case highlights the challenges in diagnosing and managing this infection, emphasizing the need for prompt surgical intervention.
Area of Science:
- Infectious Diseases
- Cardiology
- Microbiology
Background:
- Infective endocarditis (IE) poses complex clinical and management challenges.
- Actinobacillus actinomycetemcomitans (Aa) accounts for 5-10% of native valve IE.
- Aa infections are characterized by slow growth, potential for negative cultures, and systemic embolism.
Observation:
- A 59-year-old man with hypertrophic cardiomyopathy presented with fever of unknown origin after dental work.
- Transesophageal echocardiography confirmed mitral valve endocarditis.
- Blood cultures eventually isolated Actinobacillus actinomycetemcomitans.
Findings:
- The patient experienced multiple septic embolic events including skin, cerebral abscesses, spondylodiscitis, and uveitis despite antibiotic treatment.
- Surgical intervention was necessary, involving myectomy and mitral valve replacement with a mechanical prosthesis.
Implications:
- This case underscores the importance of considering rare pathogens like Aa in IE, especially with specific risk factors.
- Early and aggressive management, including surgical intervention, is crucial for favorable outcomes in complex IE cases.
- Multidisciplinary collaboration is essential for managing challenging IE presentations.
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