Successful treatment, despite a non-surgical approach, of severe infective endocarditis

Abstract

A 60-year-old man with a history of Child-Pugh class B cirrhosis was admitted to the hospital with 4-5 days of nausea, vomiting and altered mental status. Following the development of fever in the intensive care unit and methicillin-sensitive Staphylococcus aureus bacteraemia, a large (15 mm) vegetation was discovered on the anterolateral papillary muscle of the mitral valve. Following a thorough multidisciplinary evaluation, the patient was considered to be a poor surgical candidate due to the significant perioperative complications associated with Child-Pugh class B cirrhosis. The patient was treated with 6 weeks intravenous nafcillin as an outpatient. Echocardiography following the treatment course revealed that the vegetation had completely resolved without any valvular dysfunction. This case report emphasises that medical management remains an effective alternative to surgery in complicated cases of infective endocarditis.

Varicella Associated to Acute Myocardial Infarction Caused by Infective Endocarditis

“…3,8 On the echocardiogram of this case (Figure 3D), a vegetation of 28 × 8 mm can be seen on the anterolateral papillary muscle. This is an unusual implantation site for vegetations originating with other pathogens 9,10 and had not been documented for S pyogenes . The risk of rupture of vegetations and/or papillary muscles is high when the former are >10 mm in diameter and according to the criteria of the European Society of Cardiology is an indication for emergency surgery.…”