Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2025 May 21;20(1):233.
doi: 10.1186/s13019-025-03463-1.

Fatal case of streptococcal prosthetic valve endocarditis caused by Streptococcus mitis in patient with tetralogy fallot disorder: a case report

Zahra Jahani #  1 , Mina Latifian #  2 , Pooria Ahmadi  3 , Saber Esmaeili  4   5
Affiliations
Case Reports

Fatal case of streptococcal prosthetic valve endocarditis caused by Streptococcus mitis in patient with tetralogy fallot disorder: a case report

Zahra Jahani et al. J Cardiothorac Surg. .

Abstract

Background: Prosthetic valve Endocarditis (PVE) is an uncommon but potentially life-threatening infection involves a valve prosthesis or annuloplasty ring. Streptococci, including Streptococcus mitis and enterococci are major etiological agents, with studies indicating their significant role in late-onset PVE in some regions of world, staphylococci have surpassed streptococci as the most frequent causative organism. Despite challenges in diagnosis, molecular methods offer high sensitivity.

Case presentation: A 30-year-old female patient, Iranian, with a history of hypothyroidism, tetralogy of Fallot, and a bioprosthetic valve replacement and weakness after two months from exprience upper respiratory tract infection (URTI), was admitted with complaints of epistaxis, fever and worsening of shortness of breath. She exhibited symptoms of anemia, thrombocytopenia, elevated WBC, LDH, and D-dimer levels, along with splenomegaly, pleural effusions, and pulmonary congestion. Echocardiography revealed significant valve vegetation and RV failure. Despite comprehensive treatment, including cardiac surgery and antifungal therapy, her condition deteriorated, leading to cardiac arrest and death. Posthumous molecular analysis identified S. mitis as the causative agent, despite negative blood cultures.

Conclusions: This case highlights the challenges of diagnosing and treating complex PVE, particularly when conventional cultures are negative. The detection of S. mitis through molecular methods underscores the importance of early and accurate identification of pathogens in guiding effective treatment.

Keywords: Streptococcus mitis; Case report; Iran; Prosthetic valve endocarditis; Tetralogy of fallot.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: After receiving approval from the Research Ethics Committees of Shariati Hospital (IR.TUMS.SHARIATI.REC.1404.029), the case was reported. Consent for publication: Unfortunately, the patient had passed away, so informed consent was obtained from a family member (his spouse) as his legal representative. All necessary explanations were provided to him. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Consolidation that is progressing to cavitation
Fig. 2
Fig. 2
Mild to moderate plural effusion and evidence of pulmonary congestion
Fig. 3
Fig. 3
Transthoracic echocardiography imaging. RV outflow view. Mobile echogenic pulmonary valve vegetation, with an oval shape, attached to the anterior leaflet (length 23 mm, thickness 10 mm)– Red arrow
Fig. 4
Fig. 4
Transthoracic echocardiography imaging. Short axis view at Mid ventricle level. D-shaped Left ventricle in and flattening of the interventricular septum suggests RV volume overload during diastole
Fig. 5
Fig. 5
Transthoracic echocardiography imaging. Four chamber off-axis view at. Severe RV (blue arrow) and RA dilation (red arrow)
See this image and copyright information in PMC

References

    1. Piper C, Körfer R, Horstkotte DJH. Prosthet Valve Endocarditis. 2001;85(5):590–3. - PMC - PubMed
    1. Habib G, Thuny F, Avierinos J-FJP. Prosthet Valve Endocarditis: Curr Approach Therapeutic Options. 2008;50(4):274–81. - PubMed
    1. Ivert T, Dismukes W, Cobbs CG, Blackstone E, Kirklin J, Bergdahl LJC. Prosthet Valve Endocarditis. 1984;69(2):223–32. - PubMed
    1. Wang A, Athan E, Pappas PA, Fowler VG, Olaison L, Paré C et al. Contemporary clinical profile and outcome of prosthetic valve endocarditis. 2007;297(12):1354–61. - PubMed
    1. Mahesh B, Angelini G, Caputo M, Jin XY, Bryan AJTA. Prosthet Valve Endocarditis. 2005;80(3):1151–8. - PubMed

Publication types

MeSH terms

LinkOut - more resources