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Urethroplasty with Pedicled Tunica Vaginalis for the Treatment of Long-segment Anterior Urethral Stricture Caused by Lichen Sclerosus of Glans Penis
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Phalloplasty Complicated by Penile Artery Thrombosis, Recurrent Extended-Spectrum Beta-Lactamase (ESBL) Urinary Tract

Zachary Gilbert1, J P Markovic2, David Stultz2

  • 1Internal Medicine, Kettering Medical Center, Kettering, USA.

Cureus
|December 22, 2021
PubMed

Insights

This case report details Enterococcus faecalis endocarditis in a transgender male with Factor V Leiden deficiency. The infection stemmed from complications following gender-affirming surgeries and urinary tract infections.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Genitourinary Surgery

Background:

  • Enterococcus faecalis is an enteric bacterium that can cause infective endocarditis when it enters the bloodstream.
  • Infective endocarditis requires prompt diagnosis, treatment, and monitoring for successful outcomes.
  • Treatment typically involves antibiotics, with surgery sometimes necessary.

Observation:

  • A 45-year-old transgender male with Factor V Leiden deficiency presented with Enterococcus faecalis mitral valve endocarditis.
  • The endocarditis was linked to postoperative complications, including a colovesical fistula.
  • This led to an extended-spectrum beta-lactamase (ESBL) urinary tract infection (UTI) and E. faecalis bacteremia.

Findings:

  • The patient's condition was associated with recent phalloplasty, mastectomy, and vaginal eversion procedures.
  • Enterococcus faecalis bacteremia and subsequent endocarditis were identified as the primary infectious complications.
  • Factor V Leiden deficiency was noted as a comorbidity in this unique presentation.

Implications:

  • This case highlights a rare cause of infective endocarditis in a specific patient population.
  • It underscores the importance of recognizing complex infectious sequelae after genitourinary and gender-affirming surgeries.
  • Management requires a multidisciplinary approach, considering comorbidities and surgical history.
Keywords:
colovesical fistulaesbl utimitral valve endocarditispenile artery thrombosisphalloplasty

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