Gonococcal endocarditis with aortic root abscess and severe aortic insufficiency

Abstract

Gonorrhea caused by Neisseria gonorrhoeae is a very common sexually transmitted infection in the United States and World-wide (Kirkcaldy et al., 2019) [1]. The population with highest prevalence is young sexually active adults aged 15-24 years. In a majority of cases, the presentation is asymptomatic however can range from vaginitis to pelvic inflammatory disease in women. Symptoms in men can include urethritis, epididymitis and proctitis. Disseminated disease is characterized by arthritis and tenosynovitis. Gonococcal endocarditis is a rare but life-threatening complication of disseminated gonococcal infection (DGI) occurring in 1-2% of patients with DGI (Shetty et al., 2004) [3]. Gonococcal endocarditis has a predisposition for aortic valve involvement with formation of large vegetation and valvular ring abscess. Only a handful of cases have been reported in the literature since the advent of penicillin. This case highlights the importance of timely diagnosis and appropriate surgical evaluation to prevent mortality in young patients that may present with this rare complication.

Keywords: Aortic root abscess; Disseminated gonococcal infections; Gonococcal endocarditis; Neisseria gonorrhoeae; Pelvic inflammatory disease.

Fig. 1

(A) Severe deterioration of aortic valve and evidence for incomplete coaptation. Mobile echodensities that are present are likely consistent with valvular vegetations. (B) Severe aortic insufficiency. (C) Evidence of aortic root abscess.