Title : Case report: Presentation and etiology of acute on chronic infective endocarditis resulting in aortic insufficiency
Abstract:
This case describes a thirty-five year old male with past medical history of untreated hypertension for ten years was referred to the emergency department by his naturopathic primary doctor after an outpatient high sensitivity troponin test was found to be elevated in 130s. The patient only reported symptoms of a viral illness one week prior which since resolved and stated he had not been to a doctor in many years but had just established care with this doctor. Further history revealed a dental procedure about one month prior and had also had dental work about a year ago. While patient denied feeling short of breath, a family member who lived with him reported that this had been going on for one year. He reported still being able to play tennis several times per week and worked as a heavy cement mechanic. On exam, the patient was hypertensive with a significantly widened pulse pressure. Cardiac auscultation revealed a diastolic murmur that could be heard in all posts and radiated to the axilla. Further hospital workup showed enlarged cardiac silhouette on chest radiograph. Transthoracic echocardiogram showed left ventricular hypertrophy with preserved ejection fraction, and significant diastolic backflow. Blood cultures grew 2/2 positive for Strep parasanguinis. A transesophageal echocardiogram was performed to rule out vegetations and bicuspid aortic valves, which were not seen. A cardiac catheterization showed no vessel disease. Given the patient’s history and positive blood cultures, the presumed diagnosis was acute on chronic infective endocarditis. Consultation with infectious disease suggested the patient be on outpatient antibiotics through a peripherally inserted central catheter for four weeks of antibiotics. At this time, the patient’s definitive treatment and pathology is pending mechanical aortic valve replacement.
