Native aortic valve pneumococcal endocarditis - fulminant presentation

Abstract

Pneumococcal endocarditis is a rare entity, corresponding to 1 to 3% of native valve endocarditis cases. It has a typically adverse prognosis, with high mortality. There is a reported predilection for the aortic valve; thus, a common presentation is acute left heart failure. We present a case of a 60-year-old woman with a history of sinusitis, who was admitted with the diagnosis of pneumonia. She rapidly deteriorated with signs of septic shock and was transferred to the critical care unit. The transesophageal echocardiogram revealed severe aortic regurgitation due to valve vegetations. Blood cultures were positive for Streptococcus pneumoniae. She underwent cardiac surgery and had multiple postoperative complications. Nonetheless, the patient made a slow and complete recovery. Infectious endocarditis should be ruled out if any suspicion arises, and echocardiography should be performed in an early stage in patients with poor response to vasopressors and inotropes. Patients with pneumococcal endocarditis benefit from an aggressive approach, with performance of early surgery.

A Rare Case of Aortoatrial Fistula from Streptococcal Endocarditis

“…Accurate history, initial labs, imaging, and physical examination may be the first initial clues to a more serious and threatening complex process [ 4 ]. In our patient, physical exam revealed abnormal heart sounds consisting of a diastolic murmur and muffled heart sounds.…”