Mahamid Muhamad, Mashiah Jusinga, Rozner Ehud, Jabaren Mohamed, Turgeman Yoav, Koren Ofir
Heart Institute, Emek Medical Center, Afula, Israel.
Department of Infectious Diseases, Emek Medical Center, Afula, Israel.
Am J Case Rep. 2020 Sep 14;21:e923465. doi: 10.12659/AJCR.923465.
BACKGROUND Right-sided endocarditis is a well-known condition that occurs predominantly in intravenous drug users and patients with cardiovascular implantable electronic devices, central venous lines, and congenital heart disease. Most cases involve the tricuspid valve apparatus. Eustachian valve endocarditis (EVE) is a very rare and underdiagnosed condition with only a few previously reported cases. CASE REPORT We present a rare case of 2-sided infective thromboembolism from Staphylococcus aureus endocarditis involving both the eustachian and mitral valves in a 27-year-old man with mitochondrial neurogastrointestinal encephalopathy disease, which is a rare mitochondrial disease. CONCLUSIONS Endocarditis involving the eustachian valve is rare and presents a significant dilemma in diagnosis and treatment. Late diagnosis can lead to missed thromboembolic events and can have a significant impact on treatment and prognosis. In cases with high suspicion, early use of transesophageal echocardiography and chest CT can greatly advance diagnosis. The international guidelines do not specifically address patients with EVE; therefore, we recommend that the endocarditis team should be involved in any case of EVE to customize a treatment strategy.
右侧心内膜炎是一种众所周知的疾病，主要发生在静脉吸毒者以及患有心血管植入式电子设备、中心静脉导管和先天性心脏病的患者中。大多数病例累及三尖瓣装置。欧氏瓣心内膜炎（EVE）是一种非常罕见且诊断不足的疾病，此前仅有少数病例报道。病例报告：我们报告一例罕见病例，一名27岁患线粒体神经胃肠性脑病（一种罕见的线粒体疾病）的男性，因金黄色葡萄球菌心内膜炎发生双侧感染性血栓栓塞，累及欧氏瓣和二尖瓣。结论：累及欧氏瓣的心内膜炎罕见，在诊断和治疗方面存在重大难题。延迟诊断可能导致错过血栓栓塞事件，对治疗和预后产生重大影响。在高度怀疑的病例中，早期使用经食管超声心动图和胸部CT可极大地推进诊断。国际指南未专门针对EVE患者；因此，我们建议在心内膜炎治疗团队应参与任何EVE病例，以制定个性化的治疗策略。
