An Unlikely Guest: A Case Report of Pulmonary Valve Endocarditis
DOI:
https://doi.org/10.60591/crspmi.87Keywords:
Echocardiography, Endocarditis, Bacterial, Heart Valve Diseases, Pulmonary Valve, Staphylococcal InfectionsAbstract
Infective endocarditis is a serious and potentially fatal condition. Right heart involvement is less frequent, preferentially affecting the tricuspid valve, associated with intravenous drug use and with the presence of intracardiac devices. Infective endocarditis of the pulmonary valve is, therefore, very rare (1.5%-2% of cases) and its occurrence as a standalone event is even rarer, with few cases described in the literature. We report a case of native pulmonary valve endocarditis, in a woman without risk factors, with fever and onset of a holosystolic murmur, after 48 hours of hospitalization. The transthoracic echocardiogram showed unique vegetation in the pulmonary valve, which, combined with Staphylococcus aureus bacteremia, confirmed the diagnosis. Evolution was favorable, with resolution after 6 weeks of targeted antibiotic therapy. This case highlights the importance of clinical suspicion and objective examination to identify this pathology, including in the absence of typical risk factors, when diagnosis is especially challenging.
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References
Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, et al. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J. 2015;36:3075-128. doi: 10.1093/eurheartj/ehv319.
Isaza N, Shrestha NK, Gordon S, Pettersson GB, Unai S, Brizneda MV, et al. Contemporary outcomes of pulmonary valve endocarditis: A 16-year single centre experience. Heart Lung Circ. 2020;29:1799-807. doi: 10.1016/j.hlc.2020.04.015.
Shmueli H, Thomas F, Flint N, Setia G, Janjic A and Siegel RJ. Right-sided infective endocarditis 2020: Challenges and updates in diagnosis and treatment. J Am Heart Assoc. 2020;9:e017293. doi: 10.1161/JAHA.120.017293.
Antoun M, Deel J, Halpin D, Al-Akhrass F. Bacterial endocarditis of anatomically normal native pulmonic valve with no predisposing risk factors: Case report and review. Case Rep Infect Dis. 2020;2020:1453126. doi: 10.1155/2020/1453126.
Mihos CG, Nappi F. A narrative review of echocardiography in infective endocarditis of the right heart. Ann Transl Med. 2020;8:1622. doi: 10.21037/atm-20-5198
Samaroo-Campbell J, Hashmi A, Thawani R, Moskovits M, Zadushlivy D, Kamholz SL. Isolated pulmonic valve endocarditis. Am J Case Rep. 2019;20:151-3. doi: 10.12659/AJCR.913041.
Muñoz AF, Vargas DA. Right-Sided Infective Endocarditis. In: Magnusson P, Razmi R, editors. Infective Endocarditis [Internet]. London: IntechOpen; 2019 [accessed on 22 July 2022]. Available from: https://www.intechopen.
com/chapters/66084. doi: 10.5772/intechopen.85019
Saleem M, Ahmed F, Patel K, Munir MB, Ghaffar YA, Mujahid H, et al. Isolated Pulmonic Valve Endocarditis: Case Report and Review of Existing Literature on Diagnosis and Therapy. CASE. 2019;3:227-30. doi: 10.1016/j.case.2019.05.003.
Habib G, Badano L, Tribouilloy C, Vilacosta I, Zamorano JL, Galderisi M, et al. Recommendations for the practice of echocardiography in infective endocarditis. Eur J Echocardiogr. 2010;11:202-19. doi: 10.1093/ejechocard/jeq004.
Zhang MX, Zhang WM, Yu C, Zhao BW, Chen R, Pan M, et al. Isolated pulmonary valve endocarditis with rapid progression: A case report and literature review. J Cardiothorac Surg. 2021;16:16. doi: 10.1186/s13019-020-01375-w.
Acharya S, Anwar S, Iannuzzi M, Anugu V, Ghavami F. Isolated pulmonary valve endocarditis. Cureus. 2020;12:e8650. doi: 10.7759/cureus.8650.
Bamford P, Soni R, Bassin L, Kull A. Delayed diagnosis of right-sided valve endocarditis causing recurrent pulmonary abscesses: A case report. J Med Case Rep. 2019;13:97. doi: 10.1186/s13256-019-2034-7.
Moreira D, Correia E, Rodrigues B, Santos L, Capelo J, Abreu L, et al. Isolated pulmonary valve endocarditis in a normal heart. Rev Port Cardiol. 2012;31:615-7. doi: 10.1016/j.repc.2012.01.019.
Virk A, Schutte KM, Steckelberg JM, Wilson WR, Sinak LJ, Baddour LM. End-of-therapy echocardiography may not be needed in all in patients with endocarditis. Open Forum Infect Dis. 2020;7:ofaa069. doi: 10.1093/ofid/ofaa069.
Direção Geral de Saúde. Prevenção e controlo de colonização e infeção por staphylococcus aureus resistente à meticilina (MRSA) nos hospitais e unidades de internamento de cuidados continuados integrados. Norma nº 018/2014 atualizada a 27/04/2015. Direção Geral de Saúde [Internet]. [accessed on 5 december 2022]. Available from: https://normas.dgs.min-saude.pt/wp content/uploads/2019/09/prevencao-e-controlo-de-colonizacao-e-infecao-por-staphylococcus-aureus-resistente-a-meticilina-mrsa-nos-hospitais-e-unidades-de-internamento-de-cuidados-continuados-integrados.pd
