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Nocardia asteroides aortitis with perforation of the aorta
Abstract:
A 53-year-old man died of nocardial aortitis eight months after undergoing aortic valve replacement. Autopsy revealed vegetation in the area of a previous aortotomy incision and a small perforation of the aorta enclosed by pericardium immediately above the prosthetic valve ring. Prosthetic valve endocarditis was not present. Multiple splenic infarcts, microabscesses of both kidneys, and myocarditis were identified. Antemortem blood cultures and postmortem cultures of the aortic vegetation grew Nocardia asteroides.
Insights
Nocardia asteroides caused aortitis in a patient eight months after aortic valve replacement. The infection led to aortic perforation and organ damage, despite the absence of prosthetic valve endocarditis.
Area of Science:
- Cardiovascular Medicine
- Infectious Diseases
- Pathology
Background:
- Aortic valve replacement is a common procedure for valvular heart disease.
- Nocardia asteroides is an opportunistic pathogen that can cause severe infections.
Observation:
- A 53-year-old male patient developed nocardial aortitis eight months post-aortic valve replacement.
- Autopsy revealed aortic vegetation at the aortotomy incision site and a small aortic perforation near the prosthetic valve.
- Splenic infarcts, renal microabscesses, and myocarditis were also identified.
Findings:
- Cultures confirmed Nocardia asteroides in aortic vegetation and blood.
- Prosthetic valve endocarditis was notably absent.
- The infection primarily affected the aorta and surrounding structures.
Implications:
- This case highlights the potential for Nocardia asteroides to cause delayed aortitis after cardiac surgery.
- It underscores the importance of considering Nocardia in postoperative infections, even without typical endocarditis.
- Early diagnosis and treatment are crucial for managing such severe invasive infections.