Recurrent Bacteremia in the Setting of a Coronary Artery Fistula

We present an interesting case of a 31-year-old female with recurrent Staphylococcus lugdunensis bacteremia in the setting of a coronary artery fistula (CAF). Over the course of several months, the patient was admitted to the hospital on three separate occasions with an unclear source of bacteremia. She suffered from numerous complications, including cavitary pneumonia, osteomyelitis, synovitis and septic emboli. On each admission, the patient received intravenous (IV) antibiotic therapy. CT scan of the chest with contrast on the third admission revealed a prominent tortuous vessel coursing from the ascending aorta and main pulmonary artery to the left atrium. Coronary CT angiogram confirmed the presence of a fistula connecting the left circumflex artery to the coronary sinus. Common complications of CAF include infective endocarditis and myocardial ischemia; however, we report a novel case of recurrent bacteremia in the context of an anomalous coronary artery. Two months after diagnosis, surgical closure of the CAF was performed. This case illustrates the importance of utilizing different cardiac imaging modalities in order to diagnose congenital cardiac anomalies in a timely fashion and intervene appropriately.