Abstract
infective endocarditis (IE) is a serious infection associated with high mortality and severe complications. Clinical signs of IE include manifestation of local cardiac damage, embolization of septic fragments, seeding of the infection during bacteremia, and tissue injury related to antibody response. Furthermore, immunocompromised patients are considered to be at high risk for developing infective endocarditis. This report describes a case of native valve infective endocarditis complicated by abscess formation in a oncohematological young patient.
a 23-years-old male with a Hodgkin lymphoma in chemotherapy treatment, was admitted to our hospital for persistent fever, despite taking a long course of antibiotics, confusional mental state and dyspnea. Blood tests revealed anemia, neutrophilia, lymphopenia and elevated inflammatory markers (PCR, PCT, VES). The electrocardiogram showed sinus rhythm at 90 bpm with no evidence of atrio-ventricular block. S. Aureus has been isolated from the blood cultures.
The transthoracic echocardiography (TTE) showed left ventricular dilation, systolic dysfunction, a large pericardial effusion and a hyperechoic mass in the aortic root. An urgent pericardiocentesis was performed. The cytological examination of the drained fluid revealed an exudate fluid with a high proportion of neutrophils.
An urgent total body computed tomography (CT) scan was performed with no evidence of progression of malignancy, signs of pneumonia, signs of septic brain emboli. A rounded mass at aortic valve plane was detected. The mass was further evaluated with additional imaging modalities and then a transesophageal echocardiography (TEE) was performed. The exam showed: aortic posterior root abscess, involvement of left and non-coronary aortic cusps and severe aortic regurgitation.
The patient underwent urgent cardiac surgery: aortic root abscess debridement, reconstruction with autologous pericardial patch and bioprosthetic aortic valve replacement. S. Aureus was also identified in surgically removed tissue.
Twenty days after surgery, chest CT showed no complications and the transthoracic echocardiography showed a well-seated prosthetic tissue valve with a medium gradient of 13 mmHg, and good global left ventricular systolic function and ejection fraction.
infective endocarditis carries a high risk of morbidity and mortality, particularly in the immunocompromised patient. Rapid diagnosis, effective treatment, and prompt recognition of complications are essential to good patient outcome.
