Spontaneous pneumothorax as a complication of septic pulmonary embolism in an intravenous drug user: a case report

Infective endocarditis has been the major cause of morbidity and mortality among intravenous drug users (IDUs) with infections, mostly involving the tricuspid valve and presenting multiple septic pulmonary embolisms. Numerous pulmonary complications of septic pulmonary embolism have been described, but only a few have reported spontaneous pneumothorax. Our patient, a 23-year-old heroin addict, was hospitalized for tricuspid endocarditis and septic pulmonary embolism. Acute onset of respiratory distress occurred on his seventh hospital day and rapidly resulted in hypoxemia. Immediate bedside chest radiograph demonstrated left pneumothorax. It was thought to be a spontaneous pneumothorax, because he had not undergone any invasive procedure before the occurrence of pneumothorax. His clinical condition improved after the insertion of an intercostal chest tube. He later underwent surgery to replace the tricuspid valve as a result of the large size of the vegetation and poor control of infection. He ultimately survived. Pneumothorax is a possible lethal complication of septic pulmonary embolism in IDUs with right-sided endocarditis and should be considered in such patients when respiratory distress occurs acutely during their hospitalization.     

Isolated pulmonic valve endocarditis caused by group B streprococcus (Streptococcus agalactiae)--a case report and literature review

The pulmonic valve is the least commonly involved valve in infective endocarditis. Pulmonic valve endocarditis is usually associated with tricuspid valve endocarditis, and isolated pulmonic valve endocarditis is exceedingly rare. The predisposing factors for developing pulmonic valve endocarditis include a congenitally anomalous pulmonic valve, intravenous drug abuse, and the presence of indwelling intravenous or flow-directed pulmonary artery catheters. More cases of group B streptococcus endocarditis are being reported. The risk factors for group B streptococcus endocarditis include diabetes mellitus, cancer, alcoholism, malnutrition, immunocompromised status, intravenous drug abuse, postpartum and postabortion states, and underlying valvular disease. The vegetations of this type of endocarditis are usually large and have a higher tendency to result in embolism. The presentation of group B streptococcus endocarditis is usually acute and may result in rapid valve destruction if not treated promptly. A case of isolated pulmonic valve endocarditis caused by group B streptococcus, Streptococcus agalactiae, is presented that was diagnosed with multiplane transesophageal echocardiography in a 40-year old, alcoholic, malnourished man, who was successfully treated with intravenous penicillin G. The literature on the isolated pulmonic valve endocarditis caused by group B streptococcus is reviewed.     

Native Aortic Valve Endocarditis Complicated by Pseudoaneurysm of Mitral‐Aortic Intervalvular Fibrosa

Pseudoaneurysm of mitral‐aortic intervalvular fibrosa (PA‐MAIVF) is a rare complication of native aortic valve endocarditis. This region is a relatively avascular area and prone to infection during endocarditis and subsequent aneurysm formation. The rupture into the pericardial cavity and left atrium or aorta, systemic embolism, myocardial infarction secondary to left coronary compression, and sudden death are the reported complications. Herein, we present a 9‐year‐old boy who was diagnosed with bicuspid aortic valve endocarditis complicated by PA‐MAIVF, cerebral embolism, and hemorrhage. PA‐MAIVF was visualized by both two‐ and three‐dimensional transthoracic echocardiography and ruptured into pericardial space causing a fatal outcome.     

Fatal hemoptysis in acute bacterial endocarditis

Massive hemoptysis is a rare complication of bacterial endocarditis. When seen, it is most often due to septic pulmonary emboli with infarction or rupture of a mycotic aneurysm of the pulmonary artery; these conditions are usually associated with endocarditis of the tricuspid valve. We report a case of fatal hemorrhage into the lung from a mycotic aneurysm of the subclavian artery, which eroded into the left upper lobe; this condition arose as a sequela of staphylococcal endocarditis involving the mitral valve.     

Thrombus on the eustachian valve leading to recurrent pulmonary embolism: A rare problem requiring aggressive management

The eustachian valve is an embryological remnant of the inferior vena cava valve that is absent or inconspicuous in the adult. Even when prominent, it is considered to be a benign finding. The present report describes a patient with deep venous thrombosis who had recurrent pulmonary embolism despite thrombolysis and anticoagulation. He was found to have an adherent thrombus on the eustachian valve and his symptoms resolved completely following surgical thrombectomy. The present report highlights that the eustachian valve can, on rare occasions, harbour pathology and can adversely impact the outcomes of coexisting medical problems such as deep venous thrombosis. Infective endocarditis, pulmonary embolism and systemic embolism via a patent foramen ovale are the major complications of eustachian valve pathology. Transesophageal echocardiography appears to be superior to transthoracic echocardiography in identifying eustachian valve pathology and should be considered in all patients with thromboembolism without a known source.     

Diagnosis and echocardiographic course of infectious endocarditis in obstructive cardiomyopathy

A typical case of advanced obstructive cardiomyopathy in a young subject was revealed by Streptococcal mitral valve endocarditis and was diagnosed by one and two dimensional echocardiography, which revealed a pedunculated vegetation on the large mitral valve and rupture of the chordae of the small mitral valve. This was complicated by biventricular heart failure, peripheral arterial embolism in the leg due to migration of the vegetation which disappeared on the repeat echocardiography and pulmonary embolism with arterial clot emboli due to heparin-induced thrombocytopenia. This condition resolved without requiring cardiac surgery. Patients with obstructive cardiomyopathy should be treated routinely with prophylactic antibiotics, particularly when dental treatment is required. Echocardiography has become an essential examination in the diagnosis of this disease and its complications, especially in cases with infectious endocarditis.     

71-year old patient with sepsis, pericardial effusion and pulmonary infiltrates

A 71-year old man with sepsis, hemorrhagic pericardial effusion and pulmonary embolism was admitted on the intensive care unit. In blood cultures and in pericardial effusion, Staphylococcus aureus was isolated. Transeosophageal echocardiography showed a massive pulmonary valve endocarditis. Right-sided endocarditis is a rare variant of endocarditis and may occur in consequence of contaminated drug solutions or infected intravenous catheter. The prognosis is relatively good, worse prognosis show fungal infections and vegetation with a length >20 mm.     

When Enterococcus faecalis becomes a murderer

We describe the case of a 64 years old patient, known for an Enterococcus faecalis endocarditis on a 25 mm Edwards-Carpentier biological aortic valve in 2020, who was re-hospitalized one year later in cardiac surgery for a recurrence of Enterococcus faecalisbacteriemia. During hospitalization, the patient presented a cardiac arrest. The coronarography revealed an acute occlusion of the left coronary artery. The autopsy confirmed an Enterococcus faecalis thrombus on aortic valve and left coronary artery.Although systemic embolism is a common complication of infective endocarditis, septic embolism is an unsual cause of acute coronary syndrome and a very rare cause of cardiac arrest.Our case highlights a rare and potentially fatal complication of infective endocarditis: acute coronary syndrome on septic coronary embolism.     

71-j?hriger septischer Patient mit Perikarderguss und diffusen pulmonalen Infiltraten

A 71-year old man with sepsis, hemorrhagic pericardial effusion and pulmonary embolism was admitted on the intensive care unit. In blood cultures and in pericardial effusion, Staphylococcus aureus was isolated. Transeosophageal echocardiography showed a massive pulmonary valve endocarditis. Right-sided endocarditis is a rare variant of endocarditis and may occur in consequence of contaminated drug solutions or infected intravenous catheter. The prognosis is relatively good, worse prognosis show fungal infections and vegetation with a length >20?mm.     

A case of infective endocarditis accompanied with pulmonary complications in a drug addict]

A 21-year-old man who had a history of intravenous drug addiction was admitted with complaints of high fever and a productive cough. Chest CT on admission showed multiple consolidations, and pneumonia was initially diagnosed and treated. Because echocardiography after admission showed vegetation, with no bacteriological findings, attached to the tricuspid valve, right-sided infective endocarditis was diagnosed. After antibiotic therapy was changed, his fever was reduced and the inflammatory findings were eliminated. In the western world, most cases of right-side infective endocarditis are caused by drug addicts, but in Japan, this disease is very rare. Right-side infective endocarditis in drug addicts causes a high rate of pulmonary complications, in particular, septic pulmonary embolism. Many drug addicts suffering from pulmonary complications may consult doctors, but if the latter are not well-informed about this disease, it may not be possible to give an accurate diagnosis or proper treatment.     

Brucella endocarditis

Brucella endocarditis is an underdiagnosed, fatal complication of human brucellosis. Four successfully treated cases of Brucella endocarditis are reported. The development of a new valvar lesion and bulky vegetations seen on echocardiography helped to identify Brucella endocarditis occurring during systemic brucellosis. The aortic valve was affected in all four patients, and in one the mitral valve was also affected. Medical treatment did not cure the patients and all needed valve replacement--for haemodynamic deterioration in three and because a further embolism was feared in one. Antibiotics were continued for six to nine months after operation. There was no early or late mortality and no recurrence after a follow up of 15 months.     

Prophylactic resection of a tricuspid valve vegetation in infective endocarditis

A heroin addict who appeared to have recovered clinically from infective endocarditis of the tricuspid valve as judged by the usual criteria underwent prophylactic resection of a large vegetation on the tricuspid valve in order to prevent severe pulmonary embolism. Prophylactic surgery was justified by the size and as judged by cross-sectional echocardiography of the vegetation and its morphology.     

Infective endocarditis complicating patent ductus arteriosus: emergency surgical treatment of two cases

Infective endocarditis is a rare complication of patent ductus arteriosus nowadays. About two patients, aged 7 and 5 years old, we diagnosed and treated a patent ductus arteriosus complicated with an infective vegetative endocarditis with a risk of pulmonary embolism. We report in this observation this clinical and surgical experience.     

Isolated pulmonic valve endocarditis in an adult patient with ventricular septal defect and infundibular pulmonary stenosis

Ventricular septal defect associated with infundibular pulmonary stenosis is a relatively uncommon congenital cardiac defect. We report the first case of a patient with perimembranous small ventricular septal defect and infundibular stenosis suffered from pulmonary valve endocarditis and septic pulmonary embolism.     

A Rare Case of Infective Mediastinitis after Melody Valve Implantation

Pulmonary valve implant is frequently necessary in children and adults with congenital heart disease. Infective endocarditis represents a rare but life-threatening complication after transcatheter pulmonary valve implantation. There are various treatments for native or prosthetic valve endocarditis. Surgical intervention, combined with intravenous antibiotic treatment, is of paramount importance, in case of concomitant mediastinal infection, in order to ensure the radical debridement of all infected tissue, avoiding any recurrent endocarditis. In this report, we describe a rare case of mediastinitis, associated with an infected endocarditis, occurring 8 months after Melody (Medtronic^®, Minneapolis, USA) valve implant, successfully treated with the implantation of a homograft to reconstruct the right ventricular outflow tract.     

Pulmonary endarterectomy for saddling pulmonary embolism by Aspergillus fungus in an immunocompetent patient

We present a case of Tricuspid valve Aspergillus endocarditis with saddle shaped massive pulmonary embolism occurring in an immunocompetent host. The patient was managed uniquely by pulmonary endarterectomy (PEA) and combination antifungal chemotherapy with Liposomal amphotericin-B + caspofungin.     

Isolated infective endocarditis of pulmonary valve in patient with interventricular septal defect]

A case of isolated infective endocarditis of the pulmonary valve in a patient with known subpulmonary interventricular septal defect that had, as major complication pulmonary septic embolization, was reported by the authors. The disease followed an insidious course, diagnosed by the presence of vegetations in the echocardiogram, some of them larger than 1 cm. They were found in the right ventricular infundibulum and in the pulmonary valve leaflets. The isolation of Estreptococcus viridans in blood cultures has confirmed the diagnosis. In spite of appropriate antimicrobial therapy, according to the antibiogram data (with Ampicillin and Gentamicin), fever lasted for more than three weeks. This event suggested medical treatment failure and the possibility of surgery was considered. However, the endocarditis eventually healed with medical therapy alone, and this unusual course with prolonged fever was presumed to be caused by lung metastatic infection secondary to septic embolization. This complication is relatively common, but lung involvement is usually a subclinical event, not responsible for such persistent fever, as happened in the case now reported. We emphasize the rarity of this case, the unusual clinical course and the discussion concerning the therapeutic options.     

Intravenous drug addiction--staphylococcal septicemia--pulmonary embolism: a triad pathognomonic for tricuspid valve endocarditis?

28 patients (29 episodes) presenting the triad of intravenous narcotic drug addiction, Staphylococcus aureus septicemia and septic pulmonary embolism were examined for the presence of tricuspid valve endocarditis. In a prospective study, 12/13 patients examined by echocardiography had vegetations on the tricuspid valve, in 6 detected by M-mode, in 5 by 2-D technique, and in one by both methods. In 4 patients with tricuspid endocarditis, no significant murmurs were heard. Similarly, in a retrospective study, 5/16 patients not subjected to echocardiography had no murmurs consistent with tricuspid valve endocarditis. One of these patients died. In 2/16 patients the diagnosis was verified at autopsy and in 1 at heart surgery. In both groups, altogether 11 patients never developed murmurs, in 7 of them despite demonstrable vegetations. Therefore, we consider the triad to be pathognomonic for tricuspid valve endocarditis, provided that no peripheral source of emboli is present. Consequently, patients fulfilling these criteria should be treated as suffering from endocarditis. Echocardiographic examination does not seem necessary in patients with a typical clinical picture but may be helpful when chest X-rays are inconclusive or complications are suspected.     

Endocarditis of the tricuspid valve associated with congenital coronary arteriovenous fistula

A 17 year old girl with a congenital right coronary artery to coronary sinus fistula presented with recurrent septic pulmonary embolism secondary to tricuspid valve endocarditis. The diagnosis was made on the basis of echocardiography and cardiac angiography.     

Right heart complications of dual lumen tunneled venous catheters in hemodialysis patients

Seven hemodialysis patients with infected right atrial thrombi and/or tricuspid valve endocarditis are reported. All cases were attributed to use of tunneled venous catheters. Staphylococcus aureus was the preponderant organism isolated on blood culture. Therapeutic measures included antibiotics, catheter exchange, and surgery. One patient died with pulmonary embolism, and the remainder survived the infectious episodes. Experimental evidence further confirms the relationship of venous catheters placed in or proximate to the right atrium as the cause for the reported infected thrombotic and tricuspid valve complications. Measures to reduce the incidence of right heart complications must begin with recognition of the need for a surgically created arterial venous dialysis access placed early in the course of kidney disease. There is no entirely satisfactory method for prevention of venous catheter--induced endocarditis.