Infective endocarditis with left to right intracardiac fistula due to Streptococcus anginosus - a rare complication caused by an even rarer bacterium
Although infective endocarditis (IE) has been described in reports dating from the Renaissance, the diagnosis still challenges and the outcome often surprises. In the course of time, diagnostic criteria have been updated and validated to reduce misdiagnosis. Some risk factors and epidemiology have s...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
University of São Paulo
2013-12-01
|
| Series: | Autopsy and Case Reports |
| Subjects: | |
| Online Access: | http://www.revistas.usp.br/autopsy/article/view/75871 |
| _version_ | 1819178239625527296 |
|---|---|
| author | Robert Forster Fernando Peixoto Ferraz de Campos Silvana Maria Lovisolo Vera Demarchi Aiello João Augusto dos Santos Martines |
| author_facet | Robert Forster Fernando Peixoto Ferraz de Campos Silvana Maria Lovisolo Vera Demarchi Aiello João Augusto dos Santos Martines |
| author_sort | Robert Forster |
| collection | DOAJ |
| description | Although infective endocarditis (IE) has been described in reports dating from the Renaissance, the diagnosis still challenges and the outcome often surprises. In the course of time, diagnostic criteria have been updated and validated to reduce misdiagnosis. Some risk factors and epidemiology have shown dynamic changes since degenerative valvular disease became more predominant in developed countries, and the mean age of the affected population increased. Despite streptococci have been being well known as etiologic agents, some groups, although rare, have been increasingly reported (e.g., Streptococcus milleri.) Intracardiac complications of IE are common and have a worse prognosis, frequently requiring surgical treatment. We report a case of a middle-aged diabetic man who presented with prolonged fever, weight loss, and ultimately severe dyspnea. IE was diagnosed based on a new valvular regurgitation murmur, a positive blood culture for Streptococcus anginosus, an echocardiographic finding of an aortic valve vegetation, fever, and pulmonary thromboembolism. Despite an appropriate antibiotic regimen, the patient died. Autopsy findings showed vegetation attached to a bicuspid aortic valve with an associated septal abscess and left ventricle and aortic root fistula connecting with the pulmonary artery. A large thrombus was adherent to the pulmonary artery trunk and a pulmonary septic thromboemboli were also identified. |
| first_indexed | 2024-12-22T21:39:24Z |
| format | Article |
| id | doaj.art-381c16f1bebb4d1cb8eee15571ffb63e |
| institution | Directory Open Access Journal |
| issn | 2236-1960 |
| language | English |
| last_indexed | 2024-12-22T21:39:24Z |
| publishDate | 2013-12-01 |
| publisher | University of São Paulo |
| record_format | Article |
| series | Autopsy and Case Reports |
| spelling | doaj.art-381c16f1bebb4d1cb8eee15571ffb63e2022-12-21T18:11:39ZengUniversity of São PauloAutopsy and Case Reports2236-19602013-12-013473426Infective endocarditis with left to right intracardiac fistula due to Streptococcus anginosus - a rare complication caused by an even rarer bacteriumRobert Forster0Fernando Peixoto Ferraz de Campos1Silvana Maria Lovisolo2Vera Demarchi Aiello3João Augusto dos Santos Martines4Department of Internal Medicine – Hospital das Clínicas – Faculdade de Medicina – Universidade de São Paulo, São Paulo/SPDepartment of Internal Medicine – Hospital Universitário – Universidade de São Paulo, São Paulo/SPAnatomic Pathology Service – Hospital Universitário – Universidade de São Paulo, São Paulo/SPLaboratory of Pathology – Instituto do Coração – Hospital das Clínicas – Faculdade de Medicina – Universidade de São Paulo, São Paulo/SPDiagnostic Imaging Service – Hospital Universitário – Universidade de São Paulo, São Paulo/SPAlthough infective endocarditis (IE) has been described in reports dating from the Renaissance, the diagnosis still challenges and the outcome often surprises. In the course of time, diagnostic criteria have been updated and validated to reduce misdiagnosis. Some risk factors and epidemiology have shown dynamic changes since degenerative valvular disease became more predominant in developed countries, and the mean age of the affected population increased. Despite streptococci have been being well known as etiologic agents, some groups, although rare, have been increasingly reported (e.g., Streptococcus milleri.) Intracardiac complications of IE are common and have a worse prognosis, frequently requiring surgical treatment. We report a case of a middle-aged diabetic man who presented with prolonged fever, weight loss, and ultimately severe dyspnea. IE was diagnosed based on a new valvular regurgitation murmur, a positive blood culture for Streptococcus anginosus, an echocardiographic finding of an aortic valve vegetation, fever, and pulmonary thromboembolism. Despite an appropriate antibiotic regimen, the patient died. Autopsy findings showed vegetation attached to a bicuspid aortic valve with an associated septal abscess and left ventricle and aortic root fistula connecting with the pulmonary artery. A large thrombus was adherent to the pulmonary artery trunk and a pulmonary septic thromboemboli were also identified.http://www.revistas.usp.br/autopsy/article/view/75871EndocarditisBicuspid Aortic ValveStreptococcus anginosusAorta-pulmonary artery fistulaPulmonary EmbolismAutopsy. |
| spellingShingle | Robert Forster Fernando Peixoto Ferraz de Campos Silvana Maria Lovisolo Vera Demarchi Aiello João Augusto dos Santos Martines Infective endocarditis with left to right intracardiac fistula due to Streptococcus anginosus - a rare complication caused by an even rarer bacterium Autopsy and Case Reports Endocarditis Bicuspid Aortic Valve Streptococcus anginosus Aorta-pulmonary artery fistula Pulmonary Embolism Autopsy. |
| title | Infective endocarditis with left to right intracardiac fistula due to Streptococcus anginosus - a rare complication caused by an even rarer bacterium |
| title_full | Infective endocarditis with left to right intracardiac fistula due to Streptococcus anginosus - a rare complication caused by an even rarer bacterium |
| title_fullStr | Infective endocarditis with left to right intracardiac fistula due to Streptococcus anginosus - a rare complication caused by an even rarer bacterium |
| title_full_unstemmed | Infective endocarditis with left to right intracardiac fistula due to Streptococcus anginosus - a rare complication caused by an even rarer bacterium |
| title_short | Infective endocarditis with left to right intracardiac fistula due to Streptococcus anginosus - a rare complication caused by an even rarer bacterium |
| title_sort | infective endocarditis with left to right intracardiac fistula due to streptococcus anginosus a rare complication caused by an even rarer bacterium |
| topic | Endocarditis Bicuspid Aortic Valve Streptococcus anginosus Aorta-pulmonary artery fistula Pulmonary Embolism Autopsy. |
| url | http://www.revistas.usp.br/autopsy/article/view/75871 |
| work_keys_str_mv | AT robertforster infectiveendocarditiswithlefttorightintracardiacfistuladuetostreptococcusanginosusararecomplicationcausedbyanevenrarerbacterium AT fernandopeixotoferrazdecampos infectiveendocarditiswithlefttorightintracardiacfistuladuetostreptococcusanginosusararecomplicationcausedbyanevenrarerbacterium AT silvanamarialovisolo infectiveendocarditiswithlefttorightintracardiacfistuladuetostreptococcusanginosusararecomplicationcausedbyanevenrarerbacterium AT verademarchiaiello infectiveendocarditiswithlefttorightintracardiacfistuladuetostreptococcusanginosusararecomplicationcausedbyanevenrarerbacterium AT joaoaugustodossantosmartines infectiveendocarditiswithlefttorightintracardiacfistuladuetostreptococcusanginosusararecomplicationcausedbyanevenrarerbacterium |