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Streptococcus viridans Endocarditis Affecting All Four Valves.
Manish Kumar1, Emily J Anstadt1, Nerea Lopetegui Lia1
1Internal Medicine, University of Connecticut Health Center, Farmington, USA.
Cureus
|July 18, 2019
Summary
Infective endocarditis (IE) involving all four heart valves is rare. This case highlights a complex IE presentation in a patient with atrial septal defect and hypertrophic obstructive cardiomyopathy, leading to severe complications.
Area of Science:
- Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Infective endocarditis (IE) is a serious infection of the heart valves.
- Concurrent atrial septal defect (ASD) and hypertrophic obstructive cardiomyopathy (HOCM) present unique challenges in managing cardiac conditions.
Observation:
- A 47-year-old female with unrepaired ASD and HOCM presented with severe symptoms, including rash and heart failure.
- Physical examination revealed signs of systemic embolization and infection, including palpable purpura and bibasilar crackles.
- Transesophageal echocardiography (TEE) confirmed vegetation on all four heart valves, alongside the pre-existing ASD and HOCM.
Findings:
- Blood cultures identified Streptococcus viridians, and gram stain showed gram-positive cocci in chains.
- Extensive septic emboli were detected in the brain, lungs, spleen, and intestines.
- Despite initial conservative management, the patient developed cardiogenic shock and gastrointestinal bleeding.
Implications:
- This case underscores the rarity and severity of IE affecting all four valves, particularly in patients with complex congenital and structural heart disease.
- The findings emphasize the critical role of advanced imaging like TEE in diagnosing extensive valvular involvement.
- Management decisions in such complex cases require careful consideration of the extent of disease, hemodynamic stability, and potential for surgical intervention versus conservative care.
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