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Right-Side Endocarditis: A Typical Presentation in an Atypical Patient.
João P Pais1, Marta Sousa1, Rita Mota1
1Internal Medicine, Unidade Local de Saúde do Alto Minho (ULSAM) - Hospital de Santa Lúzia, Viana do Castelo, PRT.
Cureus
|November 25, 2021
Summary
Right-side endocarditis, though rarer than left-side, can affect the tricuspid valve. This case highlights the need for surgical intervention in complex cases of right-side endocarditis unresponsive to antibiotics.
Area of Science:
- Cardiology
- Infectious Diseases
Background:
- Right-side endocarditis (RSE) is less common than left-side endocarditis, with intravenous drug use and medical devices as primary risk factors.
- The tricuspid valve is the most frequently affected valve in RSE.
- While medical management is often sufficient, surgery is reserved for treatment failure or large vegetations.
Observation:
- A 70-year-old male with a history of alcohol abuse presented with symptoms suggestive of pulmonary embolism and RSE.
- Initial treatment with antibiotics and anticoagulation showed partial improvement, but symptoms recurred.
- Transthoracic echocardiogram revealed a large (20cm) tricuspid valve vegetation.
Findings:
- Blood cultures identified *Streptococcus mitis* as the causative agent.
- The patient required surgical intervention due to a poor response to antibiotic therapy.
- Post-operative recovery was favorable.
Implications:
- This case underscores the importance of considering RSE in patients with relevant risk factors and non-specific symptoms.
- Aggressive management, including surgery, may be necessary for RSE cases with large vegetations or treatment resistance.
- Early diagnosis and appropriate treatment are crucial for favorable outcomes in RSE.
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