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Case Reports
. 2022 Jun;13(6):297-301.
doi: 10.14740/jmc3943. Epub 2022 Jun 11.

Infectious Endocarditis Caused by Pseudomona aeruginosa on Bicuspid Aortic Valve

Juan Lacalzada-Almeida  1 , Maria Manuela Izquierdo-Gomez  1 , Amelia Duque-Gonzalez  1 , Maria Del Mar Alonso-Socas  2 , Rebeca Munoz-Rodriguez  1
Affiliations
Case Reports

Infectious Endocarditis Caused by Pseudomona aeruginosa on Bicuspid Aortic Valve

Juan Lacalzada-Almeida et al. J Med Cases. 2022 Jun.

Abstract

We report the case of a 53-year-old man with psoriatic arthritis, suffering from a malignant and recidivant myoepithelioma in his right axilla and arm, and undergoing two surgeries, with the last one being performed a month prior to actual admission. After the last surgery, he was admitted to hospital with fever without a source. After physical examination, laboratory tests, blood cultures and transthoracic and transesophageal echocardiography, he was diagnosed with infectious endocarditis (IE) on a bicuspid aortic valve (BAV) caused by Pseudomona aeruginosa (PA). Antibiogram-guided antibiotic therapy with meropenem and tobramicin was initiated. However, in the presence of repetitive spleen infarctions and a large vegetation, 12 days after admission, a bioprosthesis aortic valve implantation was performed. The postsurgical evolution was favorable and prolonged antibiotic course with meropenem and tobramicin was completed. The pathological anatomy and the native valve cultured confirmed an IE caused by PA. Gram-negative non-HACEK IE cases are infrequent, accounting for 1.8% of the total IE cases. PA is the second most frequent bacillus in this group, causing endocarditis more prevalently when associated with healthcare procedures rather than injectable drug use. No prior case study has identified IE caused by PA related to a BAV in the last years.

Keywords: Axillary myoepithelioma; Bicuspid aortic valve; Infectious endocarditis; Pseudomona aeruginosa.

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Conflict of interest statement

None to declare.

Figures

Figure 1
Figure 1
Trans-thoracic paraesternal long-axis view showing a bicuspid, calcified aortic valve without a definitive vegetation image (arrow).
Figure 2
Figure 2
Transesophageal long-axis view exhibiting an image compatible to a vegetation on a bicuspid aortic valve (arrow).
Figure 3
Figure 3
Transesophageal long-axis view confirming the presence of double aortic lesion (arrow).
Figure 4
Figure 4
3D transesophageal long-axis view showing the vegetation volume and its spacial relationship with the aortic valve (arrow).
Figure 5
Figure 5
Histology of the native aortic valve (hematoxylin and eosin, ×20 and ×40), showing a thickened and fibrosed valve structure with histological signs of acute endocarditis. Foci of ulceration and fibrinoleukocyte infiltrate with predominance of neutrophils can be observed.
See this image and copyright information in PMC

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