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A rocking biologic prosthetic valve: Cutibacterium acnes prosthetic valve endocarditis

Edward Dababneh1, Sylvio Carvalho Junior Provenzano2, Matthew S Yong2

  • 1Department of Cardiology, Division of Specialist Medical Services, Gold Coast Hospital and Health Services, Southport, QLD, Australia.

Hospital Practice (1995)
|February 5, 2026
PubMed

Insights

Cutibacterium acnes prosthetic valve endocarditis (PVE) is challenging to diagnose. Early PET/CT imaging and considering low-virulence pathogens are crucial for timely intervention and preventing valve damage.

Area of Science:

  • Infectious Diseases
  • Cardiology
  • Medical Imaging

Background:

  • Prosthetic valve endocarditis (PVE) caused by Cutibacterium acnes presents diagnostic challenges due to slow growth and subtle symptoms.
  • Delayed diagnosis of PVE can lead to severe complications like valve dehiscence and destruction.

Purpose of the Study:

  • To report a challenging case of PVE caused by C. acnes.
  • To emphasize the utility of advanced imaging and consideration of low-virulence pathogens in PVE diagnosis.

Main Methods:

  • A case study of a 57-year-old male with a history of aortic valve replacement and prolonged symptoms.
  • Utilized transthoracic echocardiography, transoesophageal echocardiography, PET/CT scan, and blood cultures for diagnosis.
  • Confirmed infection intraoperatively during redo aortic root and valve replacement surgery.

Main Results:

  • Initial diagnostic tests were inconclusive for PVE.
  • Positron emission tomography/computed tomography (PET/CT) revealed significant FDG uptake around the bioprosthetic valve.
  • Blood cultures eventually grew C. acnes, and intraoperative cultures confirmed the infection, revealing severe paravalvular regurgitation and near-complete valve dehiscence.

Conclusions:

  • Cutibacterium acnes should be considered in patients with indolent PVE symptoms and negative initial cultures.
  • PET/CT imaging is a valuable tool for diagnosing PVE when conventional methods fail.
  • Prompt diagnosis and treatment of C. acnes PVE are essential to prevent catastrophic valve complications.
Keywords:
CT ScanCutibacterium acnesPET scanTransoesophageal Echocardiogrpahyprosthetic valve endocarditis

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