Davita Theresia R, Giunto Nathan, Husnain Muhammad, Wong Ken
Internal Medicine, Cleveland Clinic Akron General, Akron, USA.
Internal Medicine, Northeast Ohio Medical University, Akron, USA.
Cureus. 2024 Sep 6;16(9):e68825. doi: 10.7759/cureus.68825. eCollection 2024 Sep.
In the realm of infective endocarditis, a distinct and infrequent player emerges - , an organism more commonly associated with zoonotic infections, now warranting careful consideration in this unique case report. is a Gram-negative, facultative anaerobic cocco-bacillus and a common member of the oral bacterial flora of cats and dogs. In humans, it commonly causes skin and wound infections after bites and scratches. Disseminated infection seeded into the heart valve is very rare and has only been reported in about one case per year worldwide with only 42 cases found in the literature and only five cases reported to have underlying liver cirrhosis as in our case. This is a case of a 73-year-old female with a past medical history of Child-Pugh B liver cirrhosis secondary to primary biliary cholangitis with portal hypertension, splenomegaly, pancytopenia, severe aortic stenosis, and paroxysmal atrial fibrillation presented to hospital with generalized weakness, fever, and new lower extremity rash 48 hours after last dose of antibiotic. She had recent hospitalization for left lower extremity cellulitis and bacteremia and received 14 days of high-dose oral amoxicillin-clavulanate with negative blood culture prior to discharge. She occasionally helps her son to feed his cats and dog whenever he travels. She was readmitted and a repeat blood culture showed . Transthoracic echocardiogram showed a 1.9 cm × 1 cm mobile mass attached to the anterior mitral valve leaflet, which was new compared to the prior study obtained during her first admission. She was not a suitable candidate for valve surgery due to her comorbidities. was found to be susceptible to penicillin, ampicillin, levofloxacin with negative beta lactamase. Her cellulitis, fever, and bacteremia eventually resolved with intravenous antibiotics. She was ultimately discharged with a two-week course of intravenous ceftriaxone, continued with oral levofloxacin to complete six weeks of total treatment, and followed by long-term penicillin suppression. In this case report, we delve into a rare and intriguing clinical presentation of endocarditis. Our patient is the second reported case which showed complication of native mitral valve endocarditis even in the setting of bacteremia resolution. This report sheds light on the challenging diagnosis and management of this uncommon yet clinically significant condition, highlighting the importance of vigilant and prompt intervention in cases of infective endocarditis with atypical causative agents.
在感染性心内膜炎领域，出现了一个独特且罕见的病原体—— ，这种微生物通常与人畜共患病感染相关，在这份独特的病例报告中值得仔细研究。 是一种革兰氏阴性兼性厌氧球菌杆菌，是猫和狗口腔细菌群落的常见成员。在人类中，它通常在被咬伤和抓伤后引起皮肤和伤口感染。播散性 感染累及心脏瓣膜极为罕见，全球每年仅报告约一例，文献中仅发现42例，且仅有5例报告有潜在肝硬化，如我们的病例。这是一名73岁女性，既往有原发性胆汁性胆管炎继发Child-Pugh B级肝硬化病史，伴有门静脉高压、脾肿大、全血细胞减少、严重主动脉狭窄和阵发性心房颤动，在最后一剂抗生素使用48小时后，因全身无力、发热和新发下肢皮疹入院。她近期因左下肢蜂窝织炎和菌血症住院，出院前接受了14天高剂量口服阿莫西林-克拉维酸治疗，血培养结果为阴性。她偶尔在儿子出差时帮他喂养猫和狗。她再次入院，重复血培养显示 。经胸超声心动图显示一个1.9厘米×1厘米的活动团块附着于二尖瓣前叶，与首次入院时的先前检查相比是新出现的。由于她的合并症，她不适合进行瓣膜手术。发现 对青霉素、氨苄西林、左氧氟沙星敏感，β-内酰胺酶阴性。她的蜂窝织炎、发热和菌血症最终通过静脉使用抗生素得到缓解。她最终出院时接受了为期两周的静脉注射头孢曲松治疗，继续口服左氧氟沙星以完成六周的总疗程，随后进行长期青霉素抑制治疗。在本病例报告中，我们深入探讨了 心内膜炎罕见且引人关注的临床表现。我们的患者是第二例报告病例，即使在菌血症消退的情况下，也出现了原发性二尖瓣心内膜炎的并发症。本报告揭示了这种罕见但具有临床意义的疾病在诊断和管理方面的挑战，强调了在感染性心内膜炎由非典型病原体引起的病例中进行警惕和及时干预的重要性。
