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Case Reports
. 2024 Apr 15:36:e01940.
doi: 10.1016/j.idcr.2024.e01940. eCollection 2024.

A case of prosthetic valve endocarditis and aortic abscess due to Bacillus cereus

Akina Fukushima  1   2 , Takaaki Kobayashi  3 , Yoshihito Otsuka  4 , Naoto Hosokawa  5 , Sandra Moody  6 , Miyu Takagi  1 , Akihito Yoshida  1
Affiliations
Case Reports

A case of prosthetic valve endocarditis and aortic abscess due to Bacillus cereus

Akina Fukushima et al. IDCases. .

Abstract

Bacillus cereus (B. cereus) is commonly found in the environment and is often considered a blood culture contaminant. However, in patients with specific risk factors such as intravenous drug use, central venous access catheters, immunosuppression, or prosthetic valves, B. cereus can cause severe infections. Herein, we present a case of prosthetic valve endocarditis (PVE) caused by B. cereus in an 84-year-old woman with a history of aortic valve replacement for aortic stenosis five years earlier. She presented with anorexia, and her physical examination revealed tenderness in the left upper quadrant of the abdomen. Blood culture grew B. cereus, and a CT scan showed splenic infarction, raising suspicion of PVE. Transesophageal echocardiogram (TEE) revealed an abscess around the left coronary cusp of the aortic valve and a 15 mm vegetation. Due to the patient's high risk for post-operative complications and her unwillingness to undergo surgery, the surgery was deferred. Instead, she was successfully treated with six weeks of intravenous vancomycin and discharged home. Follow-up TEE demonstrated resolution of the vegetation and valvular abscess. At her six-month post-discharge evaluation, no signs of active infection were noted including fever or worsening heart failure. Although surgery is typically recommended for most cases of PVE, conservative treatment can be considered as an alternative option for selected patients.

Keywords: Bacillus cereus; Prosthetic valve endocarditis.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Computed tomography of the abdomen with contrast obtained on the day of admission. CT of the abdomen with contrast showed a wedge-shaped low-density area in the spleen, indicating splenic infarction (yellow arrow head).
Fig. 2
Fig. 2
Transesophageal echocardiogram on hospital day 3. TEE shows a 15 mm of mobile vegetation on the aortic valve and a valve ring abscess.
Fig. 3
Fig. 3
Transesophageal echocardiogram on hospital day 38. TEE shows no vegetation or abscess.
See this image and copyright information in PMC

References

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