A 34-year-old man with a medical history of injection drug use presented with 2 weeks of weakness, nausea, vomiting and septic shock secondary to infective endocarditis of a native tricuspid valve. On admission, CT chest demonstrated multiple cavitary lesions as well as numerous small infarcts seen on MRI brain concerning for systemic septic emboli. Subsequent transthoracic echo with bubble study revealed a large patent foramen ovale (PFO). The patient later received surgical debulking of his tricuspid valve vegetation with AngioVac. Subsequently, PFO closure was performed with a NobleStitch device. The case presented here demonstrates the importance of having a high index of suspicion with right-sided endocarditis and the development of other systemic signs and symptoms. It also underscores the necessity of a multidisciplinary team of cardiologists, surgeons, infectious disease specialists and intensivists in the treatment of these complicated patients.
Infectious aortitis with the complication of aortic aneurysm carries a high mortality rate without appropriate interventions, mostly due to aortic rupture. For this reason, early and prompt diagnoses along with surgical and medical managements play critical roles. Aortic infection with Staphylococcus aureus (SA) is uncommon, but reported cases have been usually associated with fatal complication from rapid progression into rupture. We report a 65-year-old man who developed methicillin-sensitive SA aortitis and then aortic rupture. Patient was successfully treated with staged vascular repair and long-term antibiotic use.
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