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Infective Aortic Valve Endocarditis in a Patient With Mixed Connective Tissue Disease.
Leonor Boavida1, Joana Azevedo Carvalho1, Frederico Batista2
1Department of Internal Medicine IV, Hospital Professor Doutor Fernando Fonseca, Lisbon, PRT.
Cureus
|December 30, 2021
Summary
Mixed connective tissue disease patients on immunosuppression face challenges with recurrent infective endocarditis. This case shows a patient with Enterococcus faecalis endocarditis relapsing despite treatment, highlighting complex infection management.
Area of Science:
- Rheumatology
- Infectious Diseases
- Cardiology
Background:
- Mixed connective tissue disease (MCTD) shares features with SLE, scleroderma, and myositis.
- Patients with MCTD and SLE have increased risk for endocarditis.
- Immunosuppression is a known risk factor for recurrent infective endocarditis.
Observation:
- A 53-year-old female with MCTD, interstitial lung disease, and pulmonary hypertension on immunosuppressants presented with Enterococcus faecalis infective endocarditis.
- She was treated with antibiotics, but later re-admitted with influenza B and a relapse of E. faecalis endocarditis.
- Diagnosis of recurrent endocarditis was confirmed via blood cultures and transesophageal echocardiogram.
Findings:
- Recurrent Enterococcus faecalis infective endocarditis occurred in an immunosuppressed MCTD patient.
- Management was complicated by a concurrent influenza B infection.
- Successful treatment involved a prolonged antibiotic course and cardiac surgery.
Implications:
- This case underscores the challenges in managing serious infections, particularly recurrent endocarditis, in immunosuppressed patients with autoimmune diseases.
- Maintaining immunosuppression for severe autoimmune manifestations complicates infection treatment.
- Careful monitoring and aggressive management are crucial for outcomes in these complex cases.
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