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https://doi.org/10.15836/ccar2019.55

Mitral valve pseudoaneurysm – missed acute phase endocarditis case report

Blanka Glavaš Konja orcid.org/0000-0003-1134-4856 ; University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
Vlatka Lukšić Rešković ; University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
Irena Ivanac Vranešić ; University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
Majda Vrkić Kirhmajer ; University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
Zvonimir Ostojić ; University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
Marija Mance ; University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
Jelena Hucika ; University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
Jurica Šalković ; University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
Joško Bulum ; University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
Martina Lovrić Benčić ; University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
Jadranka Šeparović Hanževački ; University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia

Sažetak

Case report: 26-year-old patient with a systemic lupus erythematosus diagnosed a year ago was hospitalized because one day temperature without a concomitant increase in inflammatory laboratory parameters. At admission, the transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) showed pseudoaneurysm of the anterior mitral cusps (Figure 1, and Figure 2). Blood cultures at admission, as well as those sampled later, were all negative. One year earlier, the patient was hospitalized for febrile pancytopenia and Staphylococcus aureus septicemia. Diagnostics confirmed normal hematopoiesis but revealed systemic lupus erythematosus. Echocardiography performed early during the first hospitalization was normal (Figure 3). Antibiotic therapy was initiated. Blood culture test became negative without expected clinical recovery, so corticosteroid therapy was added. After three weeks of treatment, the patient was released home cured. Corticosteroid therapy was terminated after a gradual dose reduction. The patient felt well until the second hospitalization. Endocarditis was not confirmed during the second hospitalization, suggesting the sterile mitral valve pseudoaneurysm. Because of the potential risk for further deformation and mitral valve rupture, surgical valve reparation was suggested and done without complications.
Discussion: Infectious endocarditis is a challenging disease. Echocardiography is the basic imaging method, especially in the circumstances of the high clinical suspicious based on Duke’s criteria1. In the case of native valves, the sensitivity of TEE is 90 to 100%, and specificity 90% in the detection of vegetation, perforation or fistula2. In the detection of paravalvular abscesses, the sensitivity of TEE is 80-90% and of TTE is only 36-50%, or even less for small abscesses3. In the case of a negative echocardiographic finding and high clinical suspicion of endocarditis, TTE / TEE should be repeated 5-7 days later, in the case of S. aureus infection even earlier4. A repeated negative study should virtually rule out the diagnosis. This case highlights the importance of two echocardiographic examinations at least seven days apart if there is a doubt about endocarditis, especially in the presence of S. aureus infection as it was the case.

Ključne riječi

endocarditis; pseudoaneurysm; echocardiography; lupus erythematosus

Hrčak ID:

220577

URI

https://hrcak.srce.hr/220577

Datum izdavanja:

31.5.2019.

Posjeta: 817 *