[A case report of infective endocarditis caused by MRSA and characterized by pedicled vegetation on the posterior wall of left atrium]

Abstract

We report here a case of active infective endocarditis caused by Methicilin-Resistant Staphylococcus aureus (MRSA). A 24-year-old woman was admitted to the Osaka Medical Collage Hospital with continuous fever. After admission, MRSA was detected by blood culture and chemotherapy with Vancomycin was started. However, after 1 week, her condition had not improved. Moreover, a pedicled vegetation on the posterior wall of the left atrium and mitral regurgitation due to prolapse of the anterior leaflet were revealed by transesophageal echocardiography. The vegetation grew to about 2 cm in diameter and prolapsed into the left ventricle during diastole. We performed an early operation although the infection was still active due to its rapid growth and the risk of embolism. There was a large pedicled vegetation on the posterior wall of the left atrium as shown by preoperative echocardiography, but the mitral valve appeared to be intact. Therefore, the vegetation was completely removed and the mitral annulus was plicated by Kay's method to treat the associated mitral regurgitation. Postoperatively, we administered VCM 2 g/day for 24 days. The course was uneventful. The patient was discharged from the hospital on the 31st postoperative day.