Aortic Valve Endocarditis with Paravalvular Abscesses Caused by Erysipelothrix rhusiopathiae

Abstract

The most common manifestation of an Erysipelothrix rhusiopathiae infection is the erysipeloid, a skin lesion that in most cases occurs after professional contact with infected animals. Bacteremia occurs in less than 1% of all cases of Erysipelothrix rhusiopathiae infections [1], but 90% of these cases demonstrate an association with endocarditis [2]. When preliminary identification shows the presence of gram-positive rods in blood cultures and when the patient is a member of the population at risk, this organism should be considered as a potential causal agent.We report a case of Erysipelothrix rhusiopathiae endocarditis involving the aortic valve in a 46-year-old man who had been working as a butcher and who had a history of alcohol abuse. He was referred to our hospital because of arthralgia affecting both shoulders, weakness in the left arm, paresis of the left lower extremity, and dizziness. Four weeks before admission he had experienced night sweats and daily-recurring chills. One week later he developed an erythema exsudativum multiformelike rash localized on the upper part of his body. He was treated with 16 mg methylprednisolone daily, with continuous dose reduction for 8 days. Following this treatment the efflorescences disappeared. Two weeks before admission to the hospital, arthralgia of both shoulders had developed. Physical examination provided no conspicuous findings. Nevertheless, abdominal sonography showed hepatosplenomegaly (liver: 16 cm diameter, spleen: 16×8×8 cm diameter, both homogeneous). On admission, a physical examination showed the patient to be in a state of reduced general health. His blood pressure was 100/80 mm Hg; his pulse was regular at 100/min; and his temperature was 39°C. Auscultatory investigation revealed a systolic murmur in the right second intercostal parasternal space and a conduction in both common carotid arteries. The liver was palpably slightly enlarged. Neurological examination revealed a left-sided hemiparesis, which was more marked on the left upper extremity, and increased deep-tendon reflexes on the left side. Cranial computed tomography revealed a small hemorrhagic infarction localized on the left cortical/subcortical side. The patient's leukocyte count was 14,640/mm 3 .An electrocardiogram showed sinus tachycardia at a rate of 100/min. Mild cardiomegaly without signs of congestion or infiltrates could be seen in the chest radiograph. Transthoracic and transesophageal echocardiography showed a thickened, calcified aortic valve with mild regurgitation but without vegetations; however, a round, hypodense paravalvular structure with a diameter of 11 mm was found that was interpreted as a paravalvular abscess. Contrast-enhanced abdominal computed tomography demonstrated splenomegaly of 15×6.8×14.3 cm with a subcapsular hypodense structure of 1.8×1.2 cm that was of irregular demarcation. Following this examination, a presumptive diagnosis of a septic embolus was formulated. Antibiotic therapy was initiated that consisted of 2.2 g amoxicillin/clavulanic acid intraven...

Acute meningitis as an initial manifestation of Erysipelothrix rhusiopathiae endocarditis

“…The most severe form of human infection with E. rhusiopathiae is a rare septic form, with or without cutaneous involvement, that is most often associated with endocarditis, although cutaneous infections are the most frequent forms [8]. Subacute endocarditis with significant valvular destruction is the most common form of endocarditis due to E. rhusiopathiae.…”

Septicemia and Aortic Valve Endocarditis due toErysipelothrix rhusiopathiaein a Homeless Man

“…Valve replacement is necessary in 35%, and mortality is 40% despite early recognition and appropriate antibiotics [27]. There can be perivalvular and myocardial abscesses [28, 29]. Physicians must have a high index of suspicion for Erysipelothrix to avoid empirically prescribing ineffective agents such as vancomycin and aminoglycosides [30].…”

Empyema in spinal canal in thoracic region, abscesses in paravertebral space, spondylitis: in clinical course of zoonosis Erysipelothrix rhusiopathiae

“…Sometimes insignificant scratches, i.e. during the work, and erysipeloid, a disease of specific occupational groups, may in consequence lead to the disease generalisation as sepsis [4,5,8,14,19]. Cases of glomerulonephritis and meningitis in the course of E. rhusiopathiae infection are described [22,27,45].…”