Isolated pulmonic valve endocarditis presenting as neck pain

Area of Science:

• Cardiology
• Infectious Diseases
• Medical Case Reports

Background:

• Infective endocarditis (IE) typically affects the tricuspid or mitral valves, with right-sided IE often presenting with subtle symptoms.
• Risk factors for IE include intravenous drug use and prior dental procedures, but isolated cases can occur without these associations.

Observation:

• A 52-year-old man presented with fever, chills, night sweats, cough, and dyspnea, initially without a cardiac murmur.
• Echocardiography revealed a mass on the pulmonic valve (PV), leading to a diagnosis of isolated pulmonic valve endocarditis (PVE).
• Blood cultures identified Streptococcus oralis as the causative agent; the tricuspid valve was unaffected.

Findings:

• The patient met Duke criteria for infectious endocarditis and was treated with intravenous antibiotics.
• Symptoms rapidly resolved with antibiotic therapy, and no surgical intervention was required.
• This case underscores that isolated PVE can occur in the absence of typical risk factors and may not present with a murmur.

Implications:

• A high index of clinical suspicion for right-sided IE, including PVE, is crucial in patients with persistent fevers and pulmonary symptoms.
• Early diagnosis and prompt treatment of PVE can prevent severe complications and improve patient outcomes.
• Careful patient history and risk factor assessment are vital for the timely detection of infectious endocarditis.