Tricuspid valve infective endocarditis in a patient with psoas abscess complicated by septic pulmonary emboli and severe tricuspid regurgitation in Cameroon, challenges in the diagnosis and management in a resource limited setting: a case report

Abstract

Infective endocarditis of the tricuspid valve is rare in non-intra-venous drug abusers. Few cases of psoas abscess complicated by tricuspid infective endocarditis have been reported. A 61-year-old man underwent a laminectomy. Three weeks later he developed persistent fever, abdominal pain, back pain and hip pain, weight loss, gradually and abdominal distension. Abdomino-thoracic computed tomographic scan showed a left psoas muscle abscess and cavitary pulmonary lesions suggestive of septic pulmonary emboli. Two dimensional transthoracic echocardiography showed an oscillating mass on the anterior leaflet of the tricuspid valve compatible with a vegetation. There was severe tricuspid regurgitation with right atrial and right ventricular dilatation. Secondary psoas abscess though rare is an important cause of bacteremia and there is a potential of bacteremia progressing to serious systemic infection like tricuspid endocarditis which can be fatal without prompt and appropriate treatment.

Native Tricuspid Valve Infective Endocarditis After Breast Skin Abscess

“…Staphylococcus aureus is the most common organism causing infective endocarditis of the tricuspid valve in patients with underlying risk factors [ 2 ]. It also remains the most common pathogen in rare reports where tricuspid valve infective endocarditis occurred following psoas abscess [ 8 ], septic arthritis [ 4 ], septic abortion [ 17 ], or in cases with no clear predisposing condition [ 3 , 5 ]. Similarly, in our case, Staphylococcus aureus was the culprit pathogen following a left-sided breast skin abscess.…”

“…A diagnosis of infective endocarditis with a native tricuspid valve secondary to a left breast skin abscess was made. She developed septic pulmonary emboli [ 7 ], which have been observed in patients with native tricuspid valve endocarditis without underlying risk factors [ 8 ].…”