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Recurrent Mitral Valve Endocarditis Caused by Streptococcus pneumoniae in a Splenectomized Host

Shikha Shrestha1, Jayakrishna Chintanaboina2, Samir Pancholy1

  • 1Wright Center for Graduate Medical Education, 501 Madison Avenue, Scranton, PA 18510, USA.

Case Reports in Infectious Diseases
|January 25, 2014
PubMed

Insights

This case highlights recurrent pneumococcal endocarditis in a patient without a spleen, emphasizing aggressive treatment for this rare condition. Prompt intervention is crucial for favorable outcomes.

Area of Science:

  • Infectious Diseases
  • Cardiology
  • Immunology

Background:

  • Pneumococcal endocarditis is rare, especially in the current antibiotic era.
  • Splenectomized patients have an increased risk of severe infections, including pneumococcal sepsis.
  • Recurrent infective endocarditis poses significant management challenges.

Purpose of the Study:

  • To report a case of recurrent pneumococcal endocarditis in a splenectomized patient.
  • To emphasize the importance of aggressive management strategies for this condition.
  • To discuss the implications of splenectomy on susceptibility to recurrent pneumococcal infections.

Main Methods:

  • Case report of a 72-year-old male with a history of splenectomy and recurrent pneumococcal endocarditis.
  • Clinical presentation, laboratory findings (elevated WBC, positive blood cultures for Streptococcus pneumoniae), and diagnostic imaging (transesophageal echocardiogram) were analyzed.
  • Treatment involved intravenous ceftriaxone followed by mitral valve replacement.

Main Results:

  • The patient presented with fever and confusion, diagnosed with recurrent pneumococcal mitral valve endocarditis.
  • Blood cultures confirmed penicillin-sensitive Streptococcus pneumoniae.
  • Transesophageal echocardiogram showed mitral valve vegetation and severe mitral regurgitation, necessitating valve replacement.

Conclusions:

  • Recurrent pneumococcal endocarditis can occur even after vaccination and previous treatment.
  • Splenectomized individuals are at higher risk for severe and recurrent pneumococcal infections.
  • Aggressive treatment, including surgical intervention like valve replacement, is essential for managing recurrent pneumococcal endocarditis in high-risk patients.

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