Isolated tricuspid valve Group B Streptococcal endocarditis with septic pulmonary embolism and multiple mycotic aneurysms of the pulmonary arteries

Abstract

A diabetic woman in her 30s was admitted to our medical centre for persistent fever associated with worsening cough, easy fatigability and pleuritic chest pain noted after childbirth. Investigations revealed an isolated tricuspid valve endocarditis from Group B Streptococcus Despite appropriate antibiotic coverage, her symptoms persisted with worsening dyspnoea; hence, a CT pulmonary angiogram was done which showed septic pulmonary embolism and multiple mycotic aneurysms of the pulmonary arteries. She was treated with antibiotics and underwent tricuspid valve replacement and was discharged well with a return to her baseline functional capacity on subsequent follow-ups.

Keywords: Cardiovascular medicine; Heart failure; Infectious diseases; Valvar diseases.

Figure 1

Cardiomegaly with pulmonary congestive changes and pneumonia noted on initial chest radiograph.

Figure 2

Transthoracic echocardiogram images showing the tricuspid valve vegetation seen in the short axis view at the level of the aortic valve (left) and mild tricuspid regurgitation seen in the right ventricular inflow view (right).

Figure 3

CT pulmonary angiogram showing a dilated main pulmonary artery (top left image) and an embolus seen in the posterobasal segmental branch of the right lower lobar artery (top right—sagittal view; bottom left—coronal view; bottom right—axial view).

Figure 4

CT pulmonary angiogram showing pulmonary infarction with concomitant abscesses as peripherally enhancing hypodense regions (thick arrows) interspersed with pockets of air (thin arrows) in the right lower lung lobe (top centre—axial view; bottom left—sagittal view; bottom right—coronal view).

Figure 5

CT pulmonary angiogram 3D reconstruction showing multiple mycotic aneurysms of the (A) posterior segmental branch of the right upper lobar artery (left image), (B) middle segmental branch of the middle lobar artery (centre image) and (C) left lower lobar artery (right image).

Figure 6

Transthoracic echocardiogram images showing the increase in size of the tricuspid valve vegetation seen in the short axis view at the level of the aortic valve (left image) and worsening of the tricuspid regurgitation to moderate severity as seen in the RV inflow view (right).