Rare Case of Raoultella planticola Infective Endocarditis after Mitral Valve Replacement Surgery

Abstract

Infective endocarditis remains a condition associated with high morbidity and mortality, regardless of advances in diagnosis and therapeutics. The etiology, microbiology, and epidemiology of infective endocarditis have changed in the last years, with healthcare-associated infective endocarditis being responsible for a myriad of cases. Raoultella planticola is rarely the cause of infective endocarditis. We present a 72-year-old Caucasian female with a history of mitral valve replacement for rheumatic valve disease two months before the current presentation, without any immunosuppressive pathologies, diagnosed with Raoultella planticola infective endocarditis. Long-drawn antibiotic treatment led to a full recovery with no evidence of recurrence or relapse. This report highlights the importance of a multimodal approach for the diagnosis of bacterial etiology, the importance of selection and duration of an appropriate antibiotic regimen, and the presence of a rare opportunistic bacteria that has proven pathogenicity in a wide range of organ systems, usually in patients with several risk factors.

Keywords: Raoultella planticola; infective endocarditis; mitral valve prosthesis; rare bacteria.

Figure 1

Transthoracic echocardiography: parasternal long axis view, the zoomed image on mitral valve (apical four-chamber view), and the apical two-chambers view, the yellow arrow showing a mobile, isoechoic, homogeneous filiform mass of 10 mm, attached to the mitral prosthetic valve, with minor intra-prosthetic regurgitation.

Figure 2

Transesophageal echocardiography showing a biological prosthesis in the mitral position, with two mobile, isoechoic, homogeneous filiform masses of 10 mm attached to the posterior portion of the prosthesis on the atrial surface (yellow arrow).

Figure 3

Transesophageal echocardiography showing a biological prosthesis in the mitral position, yellow arrow showing a reduced dimensions of the vegetation compared to the previous examination. A 6 months follow-up revealed stationary aspect.