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Clinical Manifestations:

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Ruptured Root Abscess with Aortopulmonary Fistula Caused by Vancomycin-Resistant-Enterococcus Prosthetic Valve

Jessica M Gonzalez¹, Gabriel Lowenhaar², Chirag Mehta¹

¹Brown University, Rhode Island Hospital, Department of Medicine, Providence, RI.

Rhode Island Medical Journal (2013)

|March 27, 2025

Summary

This rare case highlights Vancomycin-Resistant Enterococcus (VRE) prosthetic valve endocarditis complications. Management requires balancing risks and benefits for patients with comorbidities.

Keywords:

Aortopulmonary Fistula Infective Endocarditis Complicated by Ischemic Stroke Prosthetic Valve Infective Endocarditis Ruptured Root Abscess Vancomycin-Resistant-Enterococcus Infective Endocarditis

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Area of Science:

Cardiology
Infectious Diseases
Critical Care Medicine

Background:

Prosthetic valve endocarditis caused by Vancomycin-Resistant Enterococcus (VRE) is uncommon.
Complications such as aortic root abscess and aortopulmonary fistula are rare but severe.
This case involves a 77-year-old female with a history of VRE prosthetic valve endocarditis.

Purpose of the Study:

To describe a rare case of VRE prosthetic valve endocarditis with severe complications.
To discuss the management challenges in a patient with multiple comorbidities.
To highlight the importance of individualized treatment strategies.

Main Methods:

Case report of a 77-year-old female patient.
Clinical presentation including bradycardia, hypotension, hypokalemia, and acute kidney injury.
Diagnostic workup included MRI for stroke and transesophageal echocardiogram for endocarditis assessment.
Treatment decision based on risk-benefit analysis and patient's quality-of-life goals.

Main Results:

The patient presented with VRE prosthetic valve endocarditis complicated by a ruptured aortic root abscess and an aortopulmonary fistula.
She experienced a stroke (corona radiata) and acute kidney injury.
Medical management was chosen over surgery due to high surgical risk and patient's preferences.
The case underscores the complexity of managing VRE endocarditis in patients with significant comorbidities.

Conclusions:

Optimal management for prosthetic valve endocarditis with VRE and comorbidities is not well-defined.
Treatment decisions necessitate a careful balance of risks, benefits, and patient-specific factors.
Individualized care plans are crucial for optimizing outcomes in complex cases.