IgA Vasculitis Triggered by Infective Endocarditis of Pulmonary Artery with Congenitally Corrected Transposition of the Great Arteries

Abstract

A man in his 40s with a history of congenitally corrected transposition of the great arteries (CCTGA) and closure of ventricular septal defect was referred to our hospital with purpura and hematuria. Presence of purpura, renal damage, and pathological findings on skin biopsy led to the diagnosis of IgA vasculitis (IgAV). Oral prednisolone (PSL) was initiated. However, Streptococcus pseudoporcinus was isolated from blood cultures, and transthoracic echocardiogram revealed vegetation on the pulmonary valve. From these findings, the diagnosis of infective endocarditis (IE) was made. Although the patient's condition improved after PSL interruption and antibiotic administration, his purpura relapsed. PSL readministration improved symptoms, with no further relapse even after gradual PSL dose reduction. The present case raises awareness of the importance of recognizing the occurrence of IE in IgAV patients, especially in those with congenital heart disease. CCTGA should be acknowledged as a risk factor for IE in the right-sided heart.

Fatal Streptococcus pseudoporcinus disseminated infection in decompensated liver cirrhosis: a case report

“…Herein, we present a documented fatal case of SBP associated with bacteremia due to a multidrug-resistant S. pseudoporcinus strain that rapidly resulted in MODS. Risk factors associated with invasive infection are shown in Table 4, as they emerge collectively from the seven recently reported cases [11][12][13][14][15], including our case. S. pseudoporcinus could be an emerging multidrug-resistant pathogen, as it is now more easily recognizable with the new advanced biochemical techniques.…”

“…While blood was listed as the source of five isolates, S. pseudoporcinus invasive disease was not identified in another CDC Streptococcus Laboratory population-based study of invasive disease due to betahemolytic streptococci, thus making the existence of those five S. pseudoporcinus blood isolates questionable [2]. Nevertheless, according to recently emerging cases of invasive S. pseudoporcinus infections in the literature [11][12][13][14][15], the sites of S. pseudoporcinus colonization that lead to subsequent bacteremia were presumed to be the gastrointestinal tract and the oropharynx. Regarding S. porcinus, it was first isolated from swine in 1937 and was formally described in 1985.…”

“…In a large study published in 2015, the authors speculated that S. pseudoporcinus might not be associated with invasive disease to the same extent as S. agalactiae [3]. Nonetheless, since late 2019, six new cases of severe invasive S. pseudoporcinus infection have emerged in the literature: six cases of invasive S. pseudoporcinus infections with bacteremia (four cases of endocarditis, one associated with syphilis-human immunodeficiency virus, another with a multiloculated pleural empyema [11][12][13][14]), and an additional obstetric case of maternal sepsis and fetal demise [15]. Herein, we present a documented fatal case of SBP associated with bacteremia due to a multidrug-resistant S. pseudoporcinus strain that rapidly resulted in MODS.…”

“…The pathogenetic role of S. pseudoporcinus and its prevalence in humans warrants further investigation, and may be currently underestimated due to its misidentification as S. agalactiae. Recent studies underline the potential of S. pseudoporcinus to cause severe, invasive infections via gastrointestinal/oropharynx colonization and subsequent bacteremia, leading to life-threatening diseases [11][12][13][14]. New techniques for bacterial identification in routine clinical microbiology may affect its known prevalence, revealing its true significance as a human pathogen.…”

“…Risk factors for Streptococcus pseudoporcinus acquisition and probable sites of colonization with subsequent bacteremia and severe invasive disease (6 cases[11][12][13][14][15] including the present case)…”