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Case Reports
. 2024 Nov 7;16(11):e73187.
doi: 10.7759/cureus.73187. eCollection 2024 Nov.

Recurrent Systemic Embolization From Bicuspid Aortic Valve Endocarditis in the Setting of Anti-coagulation Use

Soomal Rafique  1 , Salvador Fernandez  2 , Saliha Saleem  2 , Sami Akram  2
Affiliations
Case Reports

Recurrent Systemic Embolization From Bicuspid Aortic Valve Endocarditis in the Setting of Anti-coagulation Use

Soomal Rafique et al. Cureus. .

Abstract

Infective endocarditis (IE) is a systemic disease with a high mortality rate even with intravenous antibiotic therapy. Abnormal valves, including bicuspid aortic valves (BAV), are particularly prone to it compared to normal valves. We present a 22-year-old female who was initially admitted for the management of acute splenic infarction when she was diagnosed with a bicuspid aortic valve. With no evidence of a cardiac source of the embolus, she was discharged on anti-coagulation. However, she returned with acute toe ischemia in a few days. She was found to have Streptococcus mitis bacteremia, multiple sub-centimeter aortic valve vegetations on trans-esophageal echocardiogram (TEE), and was subsequently diagnosed with IE. After 3 weeks of IV antibiotics, she presented with thalamic stroke. Our case underscores the challenges in managing IE, particularly in young patients with BAV. Early recognition and aggressive treatment, regardless of vegetation size, and avoidance of anti-coagulation are crucial to mitigate embolic complications.

Keywords: antibiotics therapy; bicuspid aortic valve disease; infective endocarditis; intraoperative/postoperative anticoagulation; septic emboli; surgical replacement of valve.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Large acute infarct in the mid to lower portion of the spleen
Figure 2
Figure 2. TTE showing bicuspid aortic valve with no evidence of vegetation
TTE: transthoracic echocardiogram
Figure 3
Figure 3. Foot examination revealing Osler's nodes on the ventral surface of the lateral foot and 5th digit.
Figure 4
Figure 4. Transesophageal echocardiogram revealing bicuspid aortic valve with valvular vegetation
Figure 5
Figure 5. MRI brain shows right thalamic infarct
Figure 6
Figure 6. CT angiography of the head showing no significant arterial stenosis, arterial occlusion, intracranial aneurysm, or AVMs
AVM: Arteriovenous malformations
Figure 7
Figure 7. CT angiogram of the coronaries showing patent coronary arteries
See this image and copyright information in PMC

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