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Native valve emphysematous enterococcal endocarditis: expanding the differential diagnosis

Steven Tessier1, Anthony Durgham2, Matthew Krinock3

  • 1MS, Lewis Katz School of Medicine, Temple University, 3500 N Broad St, Philadelphia, PA, 19140, USA.

Germs
|January 31, 2022
PubMed
Abstract

Insights

Emphysematous endocarditis, a rare condition, was first reported caused by Enterococcus faecalis. This finding expands the known causes of this serious infection.

Area of Science:

  • Infectious Diseases
  • Cardiology
  • Microbiology

Background:

  • Emphysematous endocarditis is typically caused by gas-forming bacteria like E. coli and Citrobacter koseri.
  • Enterococcus faecalis is identified as a novel causative agent in this case.

Observation:

  • An 82-year-old male presented with fever and acute respiratory distress.
  • Echocardiography revealed severe mitral regurgitation and a large vegetation.
  • Histopathology confirmed interstitial gas accumulation, indicative of emphysematous endocarditis.

Findings:

  • Enterococcus faecalis was identified as the causative organism through vegetation sequencing.
  • The bacterium produces gas via a heme-dependent catalase, explaining the emphysematous nature.
  • The patient required mitral valve replacement due to extensive valve destruction.

Implications:

  • Enterococcus faecalis should be considered in emphysematous endocarditis differentials.
  • Histopathology is crucial for diagnosing emphysematous endocarditis alongside imaging.
  • Blood cultures are vital before antibiotic initiation for accurate diagnosis.
Keywords:
Enterococcus faecalisemphysematous endocarditisgas-forming organismmitral regurgitation

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