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Left ventricular pseudoaneurysm associated with infective endocarditis: an autopsy case report
Razuin Rahimi1,2, Nur Shafaradila Shamsul Anuar2, Noor Kaslina Mohd Kornain3
1Department of Forensic Pathology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Shah Alam, Selangor Malaysia.
Background:
Infective endocarditis (IE) is a bacterial infection of the heart valves or endocardium, with complications such as valve perforation, ring abscess, fistula, or damage to the subaortic structures. This case report aims to illustrate an atypical complication of IE which is a pseudoaneurysm depicting a periannular hemorrhage.
Case Presentation:
We describe a case of a 19-year-old male youth who presented with fever and cough a few days prior to his demise. There was no known risk factor for IE. The autopsy revealed a bulging anterior surface, upper part of the left ventricle which was soft and slightly fluctuant. Cut section of the heart revealed large vegetations affecting the right and left coronary cusps of the aortic valve. The vegetations at the left coronary cusp were mobile, with necrotic and hollow area underneath, appearing like a cavity and containing blood clots. The course of the cavity was determined to be at the periannular region and contained within the myocardium. These findings were consistent with left ventricular pseudoaneurysm. Culture of the vegetations specimen yielded growth of Granulicatella adiacens sp. anti-streptolysin O titre (ASOT) was 400 IU/mL and reported as positive.
Conclusions:
IE secondary to Granulicatella sp is rare and may result in catastrophic complications. Therefore, this case report is intended to highlight the autopsy findings of the disease as well as to create awareness of its subtle clinical symptoms.
Insights
A rare case of infective endocarditis (IE) caused by Granulicatella adiacens led to a fatal left ventricular pseudoaneurysm. Autopsy revealed subtle clinical symptoms and highlighted catastrophic complications of this rare IE cause.
Area of Science:
- Cardiology
- Infectious Diseases
- Pathology
Background:
- Infective endocarditis (IE) is a serious heart valve infection.
- Complications include valve damage, abscesses, and fistulas.
- Atypical complications like pseudoaneurysms are rare but critical.
Observation:
- A 19-year-old male presented with fever and cough.
- Autopsy revealed aortic valve vegetations and a left ventricular pseudoaneurysm.
- Granulicatella adiacens was identified as the causative agent.
Findings:
- The pseudoaneurysm was a periannular hemorrhage within the myocardium.
- Vegetations showed necrotic, hollow areas with blood clots.
- Positive anti-streptolysin O titre (ASOT) indicated a possible streptococcal link.
Implications:
- IE caused by Granulicatella species is uncommon and can have severe outcomes.
- This case highlights the importance of recognizing subtle clinical signs of IE.
- Autopsy findings are crucial for understanding rare IE complications.
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