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An Infective Endocarditis Case Report Involving Both Native Aortic and Mitral Valves Due to Streptococcus
Hüseyin Döngelli1, Baver Kızartıcı2, Mustafa Oktay Tarhan2
1Department of Internal Medicine, Dokuz Eylul Universitesi Hastanesi, Izmir, Turkey. drhuseyindongelli@gmail.com.
Abstract:
Infective endocarditis (IE) is a life-threatening disease, with its mortality rate varying depending on the infectious agent. Streptococci are among the most common causes of infective endocarditis. However, Streptococcus vestibularis has rarely been associated with human infections, typically affecting patients with underlying conditions such as immunosuppressive diseases, valve replacement, rheumatic heart disease, and hemodialysis. We present the case of a 26-year-old man who presented with fever, unanticipated weight loss, and fatigue. Although no typical risk factors for infective endocarditis were identified at admission, transesophageal echocardiography revealed a bicuspid aortic valve with calcification, paravalvular aortic abscess formation, and vegetations on the anterior leaflet of the mitral valve. Blood cultures grew S. vestibularis, which was initially sensitive to benzylpenicillin but developed emergent resistance on the third day of the antibiotic treatment. Subsequently, ceftriaxone therapy was initiated, and blood cultures became sterile on day 10. The patient eventually underwent aortic valve replacement. We report the first known case of native aortic and mitral valve endocarditis caused by S. vestibularis, accompanied by a paravalvular abscess around the native aortic valve, in a patient who had no typical risk factors for infective endocarditis, except for a bicuspid aortic valve.
Insights
This case study highlights Streptococcus vestibularis endocarditis in a young man with a bicuspid aortic valve. It details the rare infection, emergent antibiotic resistance, and successful treatment, emphasizing the importance of considering unusual pathogens in infective endocarditis.
Area of Science:
- Cardiology
- Infectious Diseases
- Microbiology
Background:
- Infective endocarditis (IE) is a severe infection with variable mortality, often caused by streptococci.
- Streptococcus vestibularis is an uncommon cause of IE, typically seen in immunocompromised patients or those with cardiac/renal conditions.
Observation:
- A 26-year-old male presented with fever, weight loss, and fatigue, lacking typical IE risk factors.
- Transesophageal echocardiography revealed native aortic and mitral valve endocarditis with a paravalvular abscess, linked to a bicuspid aortic valve.
Findings:
- Blood cultures identified Streptococcus vestibularis, which demonstrated emergent resistance to benzylpenicillin.
- Ceftriaxone therapy rendered blood cultures sterile by day 10, followed by aortic valve replacement.
Implications:
- This is the first reported case of native aortic and mitral valve endocarditis caused by S. vestibularis with a paravalvular abscess.
- The case underscores the need to consider S. vestibularis in IE, even without traditional risk factors, especially in patients with underlying valve abnormalities.
