Native and prosthetic valve infective endocarditis complicated by rapidly progressive glomerulonephritis and its diagnostic challenges and therapeutic implications

Abstract

Key clinical message: Concomitant native and prosthetic valve infective endocarditis (IE) is very rare, and both can rarely be complicated by rapidly progressive glomerulonephritis (RPGN). This diagnosis has therapeutic implications, as not all RPGN need immunosuppression therapy.

Abstract: Native and prosthetic valve infective endocarditis (IE) may be rarely complicated by rapidly progressive glomerulonephritis (RPGN). The diagnosis of IE as a cause of RPGN may be missed, and patients may be subjected to inappropriate immune suppressive therapy. Moreover, IE involving multi-valves has rarely been described, and there are only few case reports of simultaneous native and prosthetic valve endocarditis. Here, we present a case of 34-year-old female patient who has RPGN and whose initial workup missed IE. However, further workup revealed a diagnosis of native and prosthetic valve IE and our patient, who would have been subjected to inappropriate immune suppressive therapy, was treated with intravenous antibiotics alone and discharged with improvement.

Keywords: infective endocarditis; native valve endocarditis; prosthetic valve endocarditis; rapidly progressive glomerulonephritis.

FIGURE 1

Pattern of serum creatinine level.

FIGURE 2

The ECG showed features of atrial fibrillation with a fast ventricular response of 165 bpm.

FIGURE 3

Echocardiography image post‐treatment: arrow head shows aortic valve vegetation (the prosthetic mitral valve vegetation has disappeared).