No abstract

The use of (18)F-FDG PET/CT was helpful for diagnosing PVE. The results of this study support the addition of abnormal FDG uptake as a novel major criterion for PVE.

A 69-year-old woman, with an aortic bioprosthetic valve implanted 2 years before, was referred to our department because of a suspicion of endocarditis. She had experienced fever for 1 week, and Haemophilus parainfluenza was identified in 1 blood culture. The total white blood count (WBC) was 12ϫ10 9 /L, and the erythrocyte sedimentation rate (ESR) was 60 mm. The first transthoracic and transesophageal echocardiographic (TEE) studies were considered as normal. However, the 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT), performed the day after, revealed an intense fixation at the level of the bioprosthetic valve. Then, a treatment with ceftriaxone and gentamicin was started. Six days later, although fever persisted and ESR remained elevated, a second TEE showed the emergence of a periprosthetic abscess without any dehiscence (Figure 1 and Movies I and II). The lesions were confirmed during surgery performed thereafter. Case 2A 68-year-old man, with a history of aortic bioprosthetic valve implanted 4 years before and a malignant lymphoma of the skin, was referred to our department because of a suspicion of endocarditis. He had experienced recurrent fever for 1 month associated with many methicillin sensible Staphylococcus aureus-positive blood cultures. The WBC was 3.2ϫ10 9 /L, and the ESR was 105 mm. A treatment with vancomycin (allergy to penicillin) and gentamicin was started, and the first transthoracic echocardiographic study and TEE (day 1) were considered as normal. However, the 18F-FDG PET-CT, performed at day 4, revealed an intense fixation at the level of the bioprosthetic valve. Another TEE was normal at day 7. At the end of the treatment (1 month), although the WBC increased at 6.1ϫ10 9 /L and the ESR remained high, a large periprosthetic abscess with dehiscence was identified by a new TEE (Figure 2 and Movies III and IV). These lesions were confirmed during surgery. Unfortunately, the patient died 48 hours after the operation because of septic complications. Case 3A 68-year-old woman, with a history of aortic bioprosthetic valve implanted 3 years before, was referred to our department because of a suspicion of endocarditis. She had experienced recurrent fever for 4 months associated with negative blood cultures and negative serologies for Coxiella burnetii, Bartonella sp, Mycoplasma sp, Legionella sp, Aspergillus sp, and Brucella sp. The WBC was 8.3ϫ109 /L and the ESR was 61 mm. Several TEE and transthoracic echocardiographic studies remained doubtful, with a thickening of the periprosthetic tissue. Under amoxicillin plus gentamicin, and 2 days after the last TEE, the 18F-FDG PET-CT revealed an intense fixation at the level of the bioprosthetic valve. Four days after (day 6), although the WBC and ESR did not change, the patient experienced a transient ischemic attack, and a periprosthetic abscess without dehiscence was identified by a new TEE (Figure 3 and Movies V and VI). The patient underwent an urgent valve surgery, which confirmed the lesions. No microor...