Infective endocarditis with destruction of the mitral valve annulus and the left atrial posterior wall after cancer chemotherapy

The case is reported of a 48-year-old man who underwent distal pancreatectomy, splenectomy, and 4 cycles of postoperative chemotherapy for stage I pancreatic cancer, at the age of 47. Four days after completion of chemotherapy, the patient developed high-grade fever (40 degrees C). In addition, on day 10, he developed disturbance of consciousness, followed by symptoms of shock, which led to emergency hospitalization. On day 4 of admission, the patient was diagnosed as having infective endocarditis and severe mitral valve insufficiency, and was started on antibiotic and heart failure therapy. Surgery was performed on day 16 of admission; the mitral valve infection had spread to the valve cusp and ring, and thence to the posterior wall of the left atrium. After excision of the lesions, the patient underwent mitral valve replacement with a collared prosthesis valve and a translocation procedure. The postoperative course was uneventful, and there has been no recurrence of inflammation or paraprosthetic leakage over the year and 6 months since the operation.