Multiple systemic embolism in infective endocarditis underlying in Barlow's disease

Area of Science:

• Cardiology
• Infectious Diseases
• Hematology

Background:

• Systemic embolism, particularly septic embolism, is a serious complication of infective endocarditis (IE).
• Concurrent embolism to multiple organs like the brain, coronary arteries, and spleen is exceptionally rare.
• Anticoagulant use in IE is reserved for specific indications due to bleeding risks, while antiplatelet therapy's role remains controversial.

Observation:

• A previously healthy 50-year-old man presented with dysarthria due to bacterial endocarditis.
• The patient experienced multiple cerebral, coronary, splenic, and peripheral emboli, with antibiotic therapy potentially contributing to embolic events.
• An emergency splenectomy was performed, followed by mitral valve repair, with pathological findings revealing mucoid degeneration and mitral valve prolapse (Barlow's disease).

Findings:

• Antibiotic therapy for IE, while crucial for bactericidal effects, carries a risk of inducing septic embolism.
• Vegetation size and Staphylococcus aureus infection are accurate predictors of embolic events in IE.
• Bacteria can evade antimicrobial action when embedded within platelet-fibrin aggregates.

Implications:

• The case underscores the need for careful consideration of concurrent antimicrobial and antiplatelet therapy in IE patients.
• Negative blood cultures and symptom resolution do not guarantee complete bacterial eradication.
• Further research is needed to clarify the optimal use of antiplatelet agents in managing IE-related thrombosis and embolism.