Case Study: Pneumococcal Prosthetic Valve Endocarditis with Mitral Annular Abscess Fistulised in the Left Atrium: An Uncommon Germ with Dramatic End

Infective endocarditis, annular abscess, streptococcus pneumonia, mitral valve prosthesis.

Authors

  • S. Hilal Non-Invasive Cardiology Department – Military Hospital Mohamed V – Rabat
  • R. Jennane Non-Invasive Cardiology Department – Military Hospital Mohamed V – Rabat
  • S. Kaddaf Cardiac intensive care unit – Military Hospital Mohamed V – Rabat
  • A. Samih Non-Invasive Cardiology Department – Military Hospital Mohamed V – Rabat
  • H. Feliouni Non-Invasive Cardiology Department – Military Hospital Mohamed V – Rabat
  • L. Oukerraj Non-Invasive unit - Department of Cardiology B- Ign Sina Hospital – Rabat
  • A. Benyass Non-Invasive Cardiology Department – Military Hospital Mohamed V – Rabat
  • Z. Lakhal Cardiac intensive care unit – Military Hospital Mohamed V – Rabat
  • M. Cherti Non-Invasive unit - Department of Cardiology B- Ign Sina Hospital – Rabat
May 14, 2021
June 14, 2021

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Background:

Streptococcus pneumoniae is an infrequent cause of infectious endocarditis. Several case series have underscored the aggressive course of Streptocoque Pneumiae with acute clinical presentation, rapid valvular destruction, and high mortality despite appropriate antibiotic therapy.

Case summary:

We present a 74-year-old woman with previous aortic and mitral valve replacement 12 years ago, presented with a 5 days history of persistent fever and a red, hot, and swollen right knee. Atrial fibrillation was demonstrated on a 12-lead electrocardiogram. The initial echocardiography did not show any sign of endocarditis but in front of the clinical symptomatology the patient was put under probabilistic antibiotic therapy. in the meantime blood culture grew Streptocoque Pneumiae and then the antibiotic treatment was adapted. The sudden deterioration of the patient brought us back to control the heart by a transthoracic echocardiography, which revealed a mitral annular abscess fistulizing to the left atrium. the patient expired 30 days after admission from presumed severe sepsis and cardiogenic choc.

Conclusion:

Pneumococcal endocarditis in prosthetic valve is associated with very high mortality, especially when complicated by paravalvular abscess and other comorbidities. This case highlights the need for a carefull considered approach for fast and efficient care.

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