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Prosthetic valve infective endocarditis with severe mitral stenosis caused by Cutibacterium acnes: a case report
Gakuto Bando1, Taiji Okada1, Hideki Tsubota2
1Department of Cardiology, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe 650-0047, Japan.
Background:
Infective endocarditis rarely results in mitral stenosis. This report presents a case of prosthetic valve infective endocarditis caused by Cutibacterium acnes infection, which resulted in mitral stenosis and was difficult to diagnose.
Case Summary:
A 78-year-old Japanese man underwent aortic and mitral bioprosthetic valve replacement six years prior to the initiation of hormone therapy for prostate cancer. Three weeks after hormone therapy initiation, the patient developed exertional dyspnoea that progressively worsened and ultimately led to orthopnoea. Chest radiography revealed pulmonary congestion, and transthoracic echocardiography revealed mitral stenosis that was not present three months previously. The patient progressed to heart failure, and bicuspid valve replacement was performed. The excised aortic and mitral bioprosthetic valves were covered with vegetations, and pathological examination confirmed the presence of C. acnes. Therefore, the cause of mitral stenosis was infective endocarditis.
Discussion:
In patient with rapidly progressive prosthetic valve stenosis after valve replacement, infective endocarditis due to C. acnes should be suspected even if blood cultures are negative.
Insights
Prosthetic valve endocarditis from Cutibacterium acnes can cause mitral stenosis, even with negative blood cultures. This rare condition requires high suspicion for timely diagnosis and treatment.
Area of Science:
- Cardiology
- Infectious Diseases
- Pathology
Background:
- Infective endocarditis is an uncommon cause of mitral stenosis.
- Prosthetic valve endocarditis (PVE) poses diagnostic challenges.
Observation:
- A 78-year-old man developed progressive dyspnea and heart failure three weeks after starting hormone therapy for prostate cancer.
- Echocardiography revealed new-onset mitral stenosis in a patient with prior bioprosthetic valve replacement.
- Vegetations on excised prosthetic valves confirmed Cutibacterium acnes infection.
Findings:
- Cutibacterium acnes PVE resulted in severe mitral stenosis.
- The infection led to rapid clinical deterioration and heart failure.
- Diagnosis was challenging, particularly with negative initial blood cultures.
Implications:
- Cutibacterium acnes should be considered in cases of prosthetic valve stenosis, even with negative blood cultures.
- Early recognition of PVE is crucial for preventing severe complications like heart failure.
- This case highlights the importance of thorough pathological examination of explanted valves.
