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Rare case of Proteus mirabilis native mitral valve endocarditis in an immunocompromised patient

Lindsay G Grossman1, Joseph M Sharkey2, David S Grossman3

  • 1Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd., Philadelphia, PA, 19104, USA. Lindsay.Grossman@pennmedicine.upenn.edu.

BMC Infectious Diseases
|December 15, 2021
PubMed
Abstract

Insights

Proteus mirabilis infective endocarditis is rare, often linked to complicated urinary tract infections. Immunosuppression may increase risk, necessitating further research into this association.

Area of Science:

  • Infectious Diseases
  • Cardiology
  • Rheumatology

Background:

  • Bacterial infective endocarditis (IE) caused by Proteus mirabilis is uncommon.
  • The clinical course and management of Proteus mirabilis IE are not well-defined but are suspected to be linked to complicated urinary tract infections (cUTI).

Observation:

  • A 65-year-old female with rheumatoid arthritis, factor V Leiden, and a history of pulmonary embolism presented after a fall.
  • Imaging revealed splenic emboli, and a ureteral stone was suspected as the cause of complicated UTI.
  • Blood and urine cultures identified Proteus mirabilis; echocardiography showed a mitral valve vegetation.

Findings:

  • Proteus mirabilis bacteremia, originating from a complicated UTI, led to infective endocarditis.
  • The patient underwent successful mitral valve replacement.
  • Proteus mirabilis was isolated from the explanted mitral valve.

Implications:

  • Immunosuppressive therapy for rheumatoid arthritis (steroids and Janus Kinase inhibitors) may predispose patients to Gram-negative bacteremia and subsequent endocarditis.
  • Further studies are needed to explore the link between immunosuppression and Proteus species endocarditis.
Keywords:
Case reportImmunocompromisedInfective endocarditisMitral valveProteus mirabilis

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