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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
Summary
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.
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