Isolated Pulmonary Valve Infective Endocarditis With Persistent Staphylococcus aureus Bacteremia and Rapid Clearance...

Area of Science:

• Cardiology
• Infectious Diseases
• Critical Care Medicine

Background:

• Infective endocarditis (IE) typically affects the heart's left side, with right-sided IE being less common.
• Isolated native pulmonary valve IE is exceptionally rare, posing diagnostic and therapeutic challenges.
• Staphylococcus aureus is a frequent causative agent of IE, often leading to severe complications.

Observation:

• A previously healthy 59-year-old man presented with non-specific symptoms and was diagnosed with isolated pulmonary valve IE.
• Initial transthoracic echocardiography did not reveal vegetations, complicating early diagnosis.
• The patient developed persistent Staphylococcus aureus bacteremia and septic shock despite standard antibiotic treatment.

Findings:

• Transesophageal echocardiography confirmed a large vegetation on the pulmonary valve, meeting Duke's criteria for definite IE.
• An unusual salvage antibiotic regimen combining ertapenem and cefazolin achieved rapid clearance of bacteremia.
• Surgical intervention with bioprosthetic pulmonary valve replacement was necessary for near-full recovery.

Implications:

• This case highlights the diagnostic difficulties of rare right-sided IE, especially with atypical presentations.
• The combination of ertapenem and cefazolin demonstrates potential efficacy in treating persistent Staphylococcus aureus bacteremia, possibly due to synergistic activity.
• Individualized management and further research are crucial for optimizing treatment strategies in severe and persistent IE cases.