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Pneumococcal endocarditis involving the pulmonic valve in a patient with HIV

Ishan Shah1, Abu Baker Sheikh1, Shazib Sagheer2

  • 1Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico.

Proceedings (Baylor University. Medical Center)
|August 30, 2021
PubMed

Insights

Pulmonic valve endocarditis is rare, especially in HIV patients with pneumococcal bacteremia. This case highlights an unusual presentation despite pneumococcal vaccination, emphasizing the need for vigilance in diagnosing rare cardiac infections.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Immunology

Background:

  • Infective endocarditis (IE) in intravenous drug users (IVDUs) typically affects the tricuspid valve.
  • Staphylococcus aureus is the most common pathogen in IVDU-associated IE, while Streptococcus species are less frequent.
  • Pulmonic valve endocarditis is an exceptionally rare manifestation of IE.

Observation:

  • A 57-year-old male with human immunodeficiency virus (HIV) infection on antiretroviral therapy presented with sepsis.
  • The patient was found to have pneumococcal bacteremia and a vegetation on his pulmonic valve.
  • He had received both pneumococcal conjugate vaccine 13 (PCV13) and pneumococcal polysaccharide vaccine 23 (PPSV23) prior to this event.

Findings:

  • This case presents an unusual occurrence of pneumococcal endocarditis affecting the pulmonic valve.
  • The patient's prior vaccination against pneumococcal disease did not prevent this rare infection.
  • This challenges the typical understanding of causative agents and affected valves in infective endocarditis, particularly in immunocompromised individuals.

Implications:

  • This case underscores the importance of considering rare etiologies and valve involvement in infective endocarditis, even in vaccinated patients.
  • It highlights the potential for Streptococcus pneumoniae to cause endocarditis on the pulmonic valve in HIV-infected individuals.
  • Further research may be needed to understand the specific factors contributing to vaccine breakthrough infections and pulmonic valve susceptibility in this population.
Keywords:
EndocarditisHIVpneumococcalpulmonic valvevaccination

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