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[Endocarditis caused by Propionibacterium acnes -- a diagnostic and therapeutic challenge]

T Drosch1, M Egle, L Zabel

  • 1Klinik für Kardiologie, Pneumologie und Angiologie mit Schlaganfallstation, ALB FILS KLINIKEN Göppingen. tanja.drosch@kae.de

Deutsche Medizinische Wochenschrift (1946)
|February 21, 2013
PubMed
Abstract

Insights

Recurrent cardioembolic events after aortic valve replacement may indicate infective endocarditis, even without typical symptoms. Propionibacterium acnes caused endocarditis in this case, highlighting the need for vigilant monitoring.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Medical Microbiology

Background:

  • Aortic valve replacement with bioprostheses carries a risk of late complications.
  • Peripheral cerebral embolisms can be a rare but serious sequela of prosthetic valve dysfunction.

Observation:

  • A 77-year-old male presented with recurrent cerebral embolisms post-aortic valve bioprosthesis implantation.
  • Cerebral MRI revealed multiple ischemic lesions, yet infection markers were only mildly elevated.
  • Echocardiography identified vegetations and elevated gradients across the bioprosthesis, suggesting infective endocarditis.

Findings:

  • Infective endocarditis caused by Propionibacterium acnes was diagnosed, involving the aortic bioprosthesis and aortic root.
  • Initial antibiotic therapy led to remission, but a relapse occurred four months later.
  • The patient ultimately required surgical intervention following relapse.

Implications:

  • Cardioembolic events warrant suspicion for infective endocarditis, even in the absence of classic clinical signs.
  • Propionibacterium acnes, often a contaminant, can be a causative agent of prosthetic valve endocarditis.
  • Close follow-up with transesophageal echocardiography is crucial for patients managed conservatively for prosthetic valve endocarditis.

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