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Case Reports
. 2022 Mar 7;22(1):226.
doi: 10.1186/s12879-022-07220-w.

Importance of early diagnosis and surgical treatment of calcified amorphous tumor-related native valve endocarditis caused by Escherichia coli: a case report

Shu Koito  1 , Yuto Unoki  1 , Keimei Yoshida  2 , Sho Takemoto  3 , Takayuki Uchida  3 , Takashi Matono  4
Affiliations
Case Reports

Importance of early diagnosis and surgical treatment of calcified amorphous tumor-related native valve endocarditis caused by Escherichia coli: a case report

Shu Koito et al. BMC Infect Dis. .

Abstract

Background: Unlike Escherichia coli bacteremia, which is common, E. coli endocarditis is uncommon, particularly in patients with native valve, leading to its delayed diagnosis.

Case presentation: We present a case of infective endocarditis caused by E. coli in a 78-year-old Japanese man with type 2 diabetes, involving persistent bacteremia and vegetation on the mitral valve (measuring 18 × 4.2 mm in diameter). He presented with recurrent fever after antimicrobial treatment for pyelonephritis. He received antibiotic therapy for 6 weeks and required surgical removal of a calcified amorphous tumor and vegetation with mitral valvuloplasty 7 days after admission. Despite an episode of multiple cerebral infarctions, he recovered fully from the infection.

Conclusions: Follow-up blood cultures should be performed for Gram-negative bacilli bacteremia among patients with unknown focus and an atypical clinical course after treatment. Early diagnosis and aggressive surgical intervention are paramount to achieving good clinical outcomes.

Keywords: Calcified amorphous tumor; Endocarditis; Escherichia coli; Non-HACEK Gram-negative bacilli.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Transthoracic echocardiography performed on the day after admission. A hyperechoic mobile vegetation (measuring 13 × 5 mm in diameter) is detected on the P3 segment of the mitral valve, which shows annular calcification
Fig. 2
Fig. 2
Transesophageal echocardiography performed 5 days after admission. A hyperechoic and hypoechoic calcified amorphous tumor and an isoechoic to hypoechoic mobile vegetation (measuring 18 mm × 4.2 mm in diameter, overall) are detected on the posterior mitral valve leaflet in both P2 and P3 regions
Fig. 3
Fig. 3
Cranial magnetic resonance imaging performed 4 days after admission. Bilateral acute multiple cerebral infractions are observed
Fig. 4
Fig. 4
Vegetation on the mitral valve, which includes the calcified amorphous (blue arrow) and infiltration of neutrophils (yellow arrow)
See this image and copyright information in PMC

References

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