Right-sided Infective Endocarditis with a Ruptured Sinus of Valsalva and Multiple Septic Pulmonary Emboli in a Patient with Atopic Dermatitis

Right-sided infective endocarditis is frequently accompanied by septic pulmonary emboli, which may result in a spectrum of respiratory complications. We present the case of a 25-year-old woman diagnosed with infective endocarditis secondary to intravenous drug use. During a long and arduous hospital course, the patient developed empyema with bronchopleural fistula, representing severe but uncommon sequelae that may arise from this disease process. She was treated with several weeks of antibiotics as well as surgical thorascopic decortication and parietal pleurectomy.

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Tricuspid valve infective endocarditis in a non-IVDU patient with atopic dermatitis

Oxford Medical Case Reports ◽

10.1093/omcr/omaa045 ◽

2020 ◽

Vol 2020 (7) ◽

Author(s):

Heerani Woodun ◽

Sarah Bouayyad ◽

Sura Sahib ◽

Nadir Elamin ◽

Steven Hunter ◽

...

Keyword(s):

Atopic Dermatitis ◽

Infective Endocarditis ◽

Tricuspid Valve ◽

Intravenous Drug User ◽

Blood Cultures ◽

Topical Steroids ◽

Foramen Ovale ◽

History Of ◽

The Right ◽

Systemic Infections

Abstract A 29-year-old male, with chronic atopic dermatitis (AD), presented with a 2-week history of fatigue, pyrexia and weight loss. Examination showed eczematous patches with lichenified papules, erosions on the right shin and a new murmur. Blood cultures isolated methicillin-sensitive Staphylococcus aureus. Transthoracic echocardiography showed vegetation on the tricuspid valve (TV) that was adherent to the septal leaflet. He was treated for infective endocarditis, attributed to poorly controlled AD, with intravenous Flucloxacillin. Due to ongoing sepsis and pulmonary septic emboli, Clindamycin was added. He underwent TV repair; the septal leaflet was excised, and the remnant two leaflets were brought together with a ring. His patent foramen ovale was closed. His skin was treated with topical steroids and emollients. Right-sided endocarditis of an intact TV is uncommon in a non-intravenous drug user. Therefore, this novel case portrays the importance of aggressively managing AD as it is a risk factor for significant systemic infections.

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Aortic Valve Replacement and Concomitant Coronary Artery Bypass Grafting in a Patient with Infective Endocarditis and Anomalous Origin of the Right Coronary Artery from the Opposite Sinus of Valsalva

Annals of Thoracic and Cardiovascular Surgery ◽

10.5761/atcs.cr.12.01901 ◽

2013 ◽

Vol 19 (5) ◽

pp. 386-389 ◽

Cited By ~ 1

Author(s):

Sachi Koyama ◽

Keiichi Itatani ◽

Shunei Kyo ◽

Rie Aoyama ◽

Yusuke Tubokou ◽

...

Keyword(s):

Coronary Artery ◽

Infective Endocarditis ◽

Coronary Artery Bypass Grafting ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Artery Bypass ◽

Bypass Grafting ◽

Sinus Of Valsalva ◽

The Right

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Silent rupture of sinus of Valsalva aneurysm: a refutation of the Okham's razor principle

Cardiology in the Young ◽

10.1017/s1047951111000588 ◽

2011 ◽

Vol 21 (6) ◽

pp. 713-715 ◽

Cited By ~ 1

Author(s):

Joseph Dayan ◽

Suvro Sett ◽

Usha Krishnan

Keyword(s):

Infective Endocarditis ◽

Cardiac Failure ◽

Adverse Outcomes ◽

Unusual Presentation ◽

Sinus Of Valsalva ◽

Sinus Of Valsalva Aneurysm ◽

Unruptured Aneurysms ◽

Congenital Lesion ◽

History Of ◽

Physical Examinations

AbstractAneurysm of the sinus of Valsalva is an uncommon congenital lesion rarely reported in children. Unruptured aneurysms commonly go undiagnosed until a rupture has occurred. Usually, ruptured sinus of Valsalva presents with cardiac failure. There may be a history of trauma or infective endocarditis preceding the rupture. Asymptomatic paediatric presentation of ruptured sinus of Valsalva is rare. We discuss the cases of two children who presented with a murmur and were diagnosed with ruptured sinus of Valsalva. This unusual presentation in children highlights the importance of careful routine physical examinations and the evaluation of new murmurs. The Okham's razor principle states that “when you hear hoofbeats – think horses not zebras”. Sometimes, it is important to think beyond the usual in medicine, to avoid missing lesions that, if left untreated, could lead to adverse outcomes.

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A case of infective endocarditis and septic pulmonary emboli associated with leg gangrene

The Journal of the Japanese Association for Chest Surgery ◽

10.2995/jacsurg.20.171 ◽

2006 ◽

Vol 20 (2) ◽

pp. 171-174

Author(s):

Hitoshi Suzuki ◽

Keizo Tanaka ◽

Shinji Kanemitsu ◽

Toshiya Tokui

Keyword(s):

Infective Endocarditis ◽

Pulmonary Emboli

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Sinus of Valsalva Pseudoaneurysm as a Sequela to Infective Endocarditis

Texas Heart Institute Journal ◽

10.14503/thij-14-4841 ◽

2016 ◽

Vol 43 (1) ◽

pp. 46-48 ◽

Cited By ~ 3

Author(s):

Chin C. Lee ◽

Robert J. Siegel

Keyword(s):

Infective Endocarditis ◽

Antibiotic Therapy ◽

Recurrent Infection ◽

Sinus Of Valsalva ◽

Intravenous Antibiotic ◽

Severe Aortic Regurgitation ◽

Coronary Cusp ◽

Vestibular Toxicity ◽

Group B

Pseudoaneurysm is an uncommon sequela of infective endocarditis. We treated a 44-year-old man who had an active case of group B streptococcal infective endocarditis of the aortic valve despite no evidence of valvular dysfunction or vegetation on his initial transesophageal echocardiogram. After completing 6 weeks of intravenous antibiotic therapy, the patient developed a sinus of Valsalva pseudoaneurysm and severe aortic regurgitation caused by partial detachment of the left coronary cusp. We used a pericardial patch to close the pseudoaneurysm and repair the coronary cusp. This case shows the importance of routine clinical follow-up evaluation in infective endocarditis, even after completion of antibiotic therapy. Late sequelae associated with infective endocarditis or its therapy include recurrent infection, heart failure caused by valvular dysfunction (albeit delayed), and antibiotic toxicity such as aminoglycoside-induced nephropathy and vestibular toxicity.

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