Isolated pulmonary valve endocarditis in a patient with aplastic anaemia

Isolated pulmonary valve endocarditis in a patient without structural heart disease or a history of intravenous drug use

We present a case of a febrile patient in his 70s who was found to have isolated native pulmonary valve vegetations on echocardiography, and Enterococcus faecalis on blood cultures. Of note, our patient had none of the typical risk factors associated with this rare form of endocarditis previously described in only a handful of case reports.

Pneumococcal pulmonary valve endocarditis

Pulmonary valve endocarditis is an rare type of infective endocarditis (IE). Streptococcus pneumoniae is a pathogen that is uncommonly associated with IE. A 50 year-old man was referred to us to an incidental echocardiographic finding of a pulmonary valve vegetation. He had a recent admission for drainage of a scrotal abscess from which streptococcus pneumoniae was isolated, complicated by hospital acquired pneumonia and pulmonary embolism. Analysis using Polymerase Chain Reaction of the surgically resected mass revealed signs of 16S rDNA consistent with Streptococcus pneumoniae infection. This is the first confirmed case of pneumococcal pulmonary valve IE presenting entirely asymptomatically in the absence of any known risk factors.

Right-sided infective endocarditis: recent epidemiologic changes

BACKGROUND

Infective endocarditis (IE) has been increasingly reported, however, little is available regarding recent development of right-sided IE.

METHODS

Right-sided IE was comprehensively analyzed based on recent 5⅓-year literature.

RESULTS

Portal of entry, implanted foreign material, and repaired congenital heart defects were the main predisposing risk factors. Vegetation size on the right-sided valves was much smaller than those beyond the valves. Multiple logistic regression analysis revealed that predisposing risk factors, and vegetation size and locations were independent predictive risks of patients' survival.

CONCLUSIONS

Changes of right-sided IE in the past 5⅓ years included younger patient age, and increased vegetation size, but still prominent Staphylococcus aureus infections. Complication spectrum has changed into more valve insufficiency, more embolic events, reduced abscess formation, and considerably decreased valve perforations. With effective antibiotic regimens, prognoses of the patients seemed to be better than before.