Pneumococcal native aortic valve endocarditis with mycotic abdominal aortic aneurysm, paraspinal and iliopsoas abscesses and pneumonia revealing a multiple myeloma

Abstract

We report a rare case of multiple myeloma presenting with native aortic valve endocarditis with secondary embolic mycotic abdominal aortic aneurysm, contiguous paraspinal and iliopsoas abscesses, and pneumonia due to Streptococcus pneumoniae in a Chinese man. He was treated with aortic valve replacement, endovascular stenting of aneurysm, image-guided drainage of abscesses, and a 6-week course of endocarditic antibiotic therapy followed by chronic suppressive antibiotic therapy. Cases of multiple myeloma presenting with invasive pneumococcal infection were reviewed.

Features and treatment modality of iliopsoas abscess and its outcome: a 6-year hospital-based study

“…These imaging modalities can clearly delineate adjacent structures, especially the vertebrae and epidural space, and it is therefore likely that the infectious focus will be clarified. Furthermore, in our report, 11 patients of secondary IPA originated from cardiovascular system, including abdominal aortic aneurysm (AAA) post-stent implantation with subsequent infection, infected aortic aneurysm, and infective endocarditis, all of which have rarely been mentioned in the literature [14,15]. …”

First Two Cases of Infected Aortic Aneurysm Caused by Non-VaccineStreptococcus pneumoniaeSerotype 23A

“…However, 14-40% of IAA cases are culture-negative [1]. IAA due to Streptococcus pneumoniae is rare, and reports of the involvement of S. pneumoniae capsular serotypes and sequence types (STs) in IAA are even rarer [2][3][4][5]. We identified S. pneumoniae from culture-negative IAA by genetic analysis.…”

“…To the best of our knowledge, as of 2019, only 59 cases of pneumococcal IAA have been reported in France, the United Kingdom (UK), the Netherlands, Germany, Switzerland, Belgium, Denmark, the United States (USA), Canada, Chile, Japan, Hong Kong, Korea, and Austria since 1977 [2][3][4][5]. In the previous cases of IAA due to S. pneumoniae, capsular serotype analysis was reported only for seven: 10A and 23F in the UK, 4 and 8 in Denmark, 19F in Hong Kong, 4 in Belgium, and 23 in USA [2][3][4][5]. We report the first two cases of culture-negative IAA due to non-vaccine S. pneumoniae serotype 23A, ST338.…”

Streptococcus agalactiae Native Valve Endocarditis: Uncommon Presentation of Multiple Myeloma

“…Occasionally, the first manifestation of an underlying MM may be an episode of acute bacterial infection. 4 Adults with chronic immunosuppressive conditions are at an increased risk for Streptococcus agalactiae endocarditis, 5 which is characterized by acute onset, large vegetations, rapid valvular destruction and frequent complications. 6 Its clinical course is more aggressive than IE caused by other Streptococcus species 6 and the mortality rate exceeds 40%.…”