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Occult prosthetic aortic valve endocarditis caused by Propionibacterium acnes: a case report

M Servito1, A L Fernández2, S Culhane1

  • 1Kingston Health Science Centre, Kingston, Ontario, Canada.

Annals of the Royal College of Surgeons of England
|April 21, 2022
PubMed

Insights

This case highlights a rare mechanical aortic valve endocarditis caused by Propionibacterium acnes (P. acnes). It suggests antibiotic prophylaxis for patients with prosthetic valves undergoing gastric procedures.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Surgical Infections

Background:

  • Prosthetic valve endocarditis (PVE) is a serious complication following cardiac surgery.
  • Propionibacterium acnes (P. acnes) is an uncommon cause of PVE, often associated with delayed onset infections.

Observation:

  • A patient presented with progressive dyspnea and worsening aortic valve gradients five years post-surgery.
  • Past medical history included gastric band removal and bypass surgery two years before cardiac reoperation.
  • No cardinal symptoms of infection were present during initial presentation.

Findings:

  • Occult mechanical aortic valve endocarditis caused by P. acnes was diagnosed.
  • P. acnes was isolated from prosthetic valve cultures, but blood cultures were negative.
  • The patient successfully underwent redo bioprosthetic aortic valve replacement and recovered after a six-week antibiotic course.

Implications:

  • This case underscores the importance of considering P. acnes in delayed-onset PVE, especially after gastrointestinal procedures.
  • It raises the question of antibiotic prophylaxis for endocarditis in patients with prosthetic heart valves undergoing gastric surgery.
  • Highlights the need for a thorough patient history, including prior surgeries, in diagnosing PVE.
Keywords:
EndocarditisPropionibacterium acnesProsthetic valve endocarditis

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