Posters
Academic Level (Author 1)
Resident
Discipline/Specialty (Author 1)
Internal Medicine
Academic Level (Author 2)
Resident
Discipline/Specialty (Author 2)
Internal Medicine
Academic Level (Author 3)
Resident
Discipline/Specialty (Author 3)
Internal Medicine
Academic Level (Author 4)
Resident
Discipline/Specialty (Author 4)
Internal Medicine
Discipline Track
Clinical Science
Abstract
Introduction: Infective endocarditis (IE) typically targets a single valve, with involvement of more valves being rare. Timely targeted therapy hinges on identifying the responsible microorganism through blood culture. However, blood culture-negative endocarditis (BCNE), representing 5% of all endocarditis cases, poses diagnostic challenges and is associated with higher long-term mortality rates compared to blood culture-positive endocarditis (BCPE).
Case Presentation: A 53-year-old male with a history of congestive heart failure (CHF), end stage renal disease on peritoneal dialysis, and 30- years of cocaine use presented with an abnormal echocardiogram. The patient reported a two-week history of chills, sweat, generalized weakness, and exertional dyspnea. Physical examination revealed poor dentition, a Grade III/VI systolic murmur radiating to the axilla, and a peritoneal dialysis catheter in the left upper quadrant without signs of infection. Laboratory tests indicated leukocytosis and elevated inflammatory markers. Blood cultures and serologies for Streptococcus Group A, Brucella, and Q fever were negative. Transesophageal echocardiography showed a freely mobile echodense mass (1.2x0.9 cm) on the A2 segment of the mitral valve with mitral regurgitation, and multiple freely mobile echodense masses on the aortic valve leaflets. Despite negative blood cultures, the patient was treated empirically with Daptomycin, Levofloxacin, and Cefepime for six weeks, given the high suspicion of infective endocarditis based on clinical and echocardiographic findings
Discussion: Similar to the case presented, IE presents challenges due to varied clinical presentations and complications. Moreover, multivalve IE, has significant clinical implications. Furthermore, BCNE complicates diagnosis and delays treatment initiation. However, recognizing predisposing factors like CHF, renal disease, and substance abuse is crucial. Despite negative blood cultures, systemic symptoms and abnormal echocardiographic findings warrant a high suspicion for IE, prompting empirical antibiotic therapy, guided by clinical and echocardiographic findings.
Conclusion: Multivalve involvement, though rare, carries significant clinical implications. BCNE complicates diagnosis and has higher long-term mortality than BCPE. This case underscores the need for heightened suspicion in high-risk patients, urging empirical antibiotic therapy based on clinical and echocardiographic findings is crucial for optimizing outcomes in suspected cases of IE.
Presentation Type
Poster
Recommended Citation
Rojas Huen, Jennifer; Alejos Aguero, Carlos Luis; Ngo, Duc Khiem; and Torres Perez, Maria E., "Stealthy Intrusion: Multivalve Culture-Negative Infective Endocarditis" (2024). Research Colloquium. 86.
https://scholarworks.utrgv.edu/colloquium/2024/posters/86
Included in
Stealthy Intrusion: Multivalve Culture-Negative Infective Endocarditis
Introduction: Infective endocarditis (IE) typically targets a single valve, with involvement of more valves being rare. Timely targeted therapy hinges on identifying the responsible microorganism through blood culture. However, blood culture-negative endocarditis (BCNE), representing 5% of all endocarditis cases, poses diagnostic challenges and is associated with higher long-term mortality rates compared to blood culture-positive endocarditis (BCPE).
Case Presentation: A 53-year-old male with a history of congestive heart failure (CHF), end stage renal disease on peritoneal dialysis, and 30- years of cocaine use presented with an abnormal echocardiogram. The patient reported a two-week history of chills, sweat, generalized weakness, and exertional dyspnea. Physical examination revealed poor dentition, a Grade III/VI systolic murmur radiating to the axilla, and a peritoneal dialysis catheter in the left upper quadrant without signs of infection. Laboratory tests indicated leukocytosis and elevated inflammatory markers. Blood cultures and serologies for Streptococcus Group A, Brucella, and Q fever were negative. Transesophageal echocardiography showed a freely mobile echodense mass (1.2x0.9 cm) on the A2 segment of the mitral valve with mitral regurgitation, and multiple freely mobile echodense masses on the aortic valve leaflets. Despite negative blood cultures, the patient was treated empirically with Daptomycin, Levofloxacin, and Cefepime for six weeks, given the high suspicion of infective endocarditis based on clinical and echocardiographic findings
Discussion: Similar to the case presented, IE presents challenges due to varied clinical presentations and complications. Moreover, multivalve IE, has significant clinical implications. Furthermore, BCNE complicates diagnosis and delays treatment initiation. However, recognizing predisposing factors like CHF, renal disease, and substance abuse is crucial. Despite negative blood cultures, systemic symptoms and abnormal echocardiographic findings warrant a high suspicion for IE, prompting empirical antibiotic therapy, guided by clinical and echocardiographic findings.
Conclusion: Multivalve involvement, though rare, carries significant clinical implications. BCNE complicates diagnosis and has higher long-term mortality than BCPE. This case underscores the need for heightened suspicion in high-risk patients, urging empirical antibiotic therapy based on clinical and echocardiographic findings is crucial for optimizing outcomes in suspected cases of IE.