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Published on: May 27, 2015
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Listeria Endocarditis: A Diagnostic Challenge
Wilhelmina J A R M Valckx1, Suzanne P M Lutgens1, Hortence E Haerkens-Arends1
1Jeroen Bosch Hospital, Den Bosch, the Netherlands.
Summary
Diagnosing Listeria monocytogenes endocarditis is challenging. An 18F-FDG PET-CT scan aided in identifying infection in a patient with prosthetic valve endocarditis, leading to successful treatment.
Area of Science:
- Cardiology
- Infectious Diseases
- Nuclear Medicine
Background:
- Listeria monocytogenes endocarditis is a rare but serious infection, particularly in immunocompromised patients.
- Prosthetic valve endocarditis presents diagnostic challenges, often requiring advanced imaging.
- A 74-year-old hemodialysis patient with multiple cardiac interventions developed recurrent fever after initial antibiotic treatment for pneumonia.
Purpose of the Study:
- To investigate the utility of 18F-FDG PET-CT in diagnosing prosthetic valve endocarditis caused by Listeria monocytogenes.
- To highlight the diagnostic challenges and successful management of a complex endocarditis case.
Main Methods:
- Case report of a 74-year-old hemodialysis patient with suspected endocarditis.
- Utilized transthoracic and transesophageal echocardiography, blood cultures, and 18F-FDG PET-CT imaging.
- Administered amoxicillin for treatment, with extended duration based on clinical response.
Main Results:
- Blood cultures confirmed Listeria monocytogenes; initial echocardiography was negative for endocarditis.
- Recurrent fever post-antibiotics and positive minor Duke criteria prompted 18F-FDG PET-CT.
- 18F-FDG PET-CT revealed increased activity in the aortic root, ascending aorta, and heart, supporting Listeria monocytogenes endocarditis.
- Extended amoxicillin therapy resulted in a good clinical outcome.
Conclusions:
- 18F-FDG PET-CT is a valuable tool for diagnosing challenging cases of prosthetic valve endocarditis, especially when conventional methods are inconclusive.
- Early and accurate diagnosis of Listeria monocytogenes endocarditis is crucial for effective treatment and patient survival.
- Multimodality imaging and prolonged antibiotic therapy are essential for managing complex endocarditis cases.
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