A 23 y.o. woman comes to the ED with RUQ pain

What two things do you notice on her abdominal CT?

Our patient had strep mitis endocarditis with septic emboli to the kidney and spleen.  Native valve endocarditis is uncommon in  individuals who do not use IV drugs with an  incidence of  10 per 100,000 person years. A vegetation is formed after endothelial damage causes platelets and fibrin to form a sterile vegetation first which eventually becomes colonized with bacteria.  In the case of our patient the bacteremia was felt to be secondary to poor dentition.

mitral valve endocarditis post resection

Four mechanisms cause most of the clinical features of endocarditis.

1.       Valve destruction

2.       Paravalvular extension of infection with heart failure

3.       Embolization of vegetations with infection of target organs

4.       Immunologic phenomena-hypocomplementemic glomerulonephritis, false positive tests for syphilis, ANA and rheumatoid factor.

janeway lesions are often flat areas on the palms.

The Duke Criteria are often used for the diagnosis of infective endocarditis.

MAJOR CRITERIA

Positive blood cultures

+ echo

New valvular regurgitation

MINOR CRITERIA

Fever >38

Predisposing cardiac condition like bicuspid aortic valve or IV drug use

Evidence of systemic emboli

Immunologic phenomenon: glomerulonephritis, osler nodes, roth spots, rheumatoid factor

oslers nodes are more nodular than Janeway lesions but they can be confused.

World wide gram-positive bacteria account for 80% of cases of native-valve endocarditis. Staph accounts for 40% of cases , strep in 40%and enterococci in 10%.  HACEK species are isolated in 5% of cases. If blood cultures are negative consider the “culture-negative” causes of endocarditis listed below

Our patient developed valvular insufficiency and embolized to the circumflex causing an MI and cardiogenic shock.  She required a valve replacement.  She developed arrhythmias and required a pacemaker.  She remains on pressors and bipap.

Patterson J. 2016. The Vasculopathic Reaction Pattern. Weedon’s Skin Pathology ( 4th ed.)  Churchill Livingston . PP. 239-240.

Chambers H, Bayer A. Native-Valve Infective Endocarditis. Aug 6, 2020;383:567-

Cahill T, Prendergast B. Infective endocarditis. Lancet 2016;387:882-93. Our patient had mitral valve endocarditis, threw a clot to her circumflex  and developed cardiogenic

Holland T, Arnold C, Fowler V. clinical managemen of Staphylococcus aureus bacteremia: a review. JAMA 2014;312:1330-41.

Brougui P, Raoult D. Endocarditis due to rare and fastidious bacteria. Clin Microbiol Rev. 2001 Jan;14(1):177-207.