Authors

• Drazen Zekanovic — Zadar General Hospital, Zadar, Croatia — ORCID: 0000-0002-8147-6574
• Dino Mikulic — Zadar General Hospital, Zadar, Croatia — ORCID: 0000-0002-3785-1584
• Mira Stipcevic — Zadar General Hospital, Zadar, Croatia — ORCID: 0000-0003-4351-1102
• Marin Bistirlic — Zadar General Hospital, Zadar, Croatia — ORCID: 0000-0002-9213-4174
• Jogen Patrk — Zadar General Hospital, Zadar, Croatia — ORCID: 0000-0002-8165-692X
• Zoran Bakotic — Zadar General Hospital, Zadar, Croatia — ORCID: 0000-0002-7095-0111
• Karla Savic — Zadar General Hospital, Zadar, Croatia — ORCID: 0000-0002-1339-8922
• Karla Grgic — Zadar General Hospital, Zadar, Croatia — ORCID: 0000-0003-3512-9472
• Stipe Kosor — Zadar General Hospital, Zadar, Croatia — ORCID: 0000-0002-2813-9026
• Nikola Verunica — Zadar General Hospital, Zadar, Croatia — ORCID: 0000-0003-2480-9106

Abstract

**Introduction**: Infective endocarditis remains life-threatening disease with in-hospital mortality of 15-30%. This entity represents complex interaction between pathogen, host immune system and coagulation cascade. (1-3) However, routine anticoagulation therapy in this setting is not recommended by the official guidelines. **Case report**: Patient with bioprosthetic aortic valve was admitted for abdominal pain and elevated inflammation markers. Artificial valve vegetations were confirmed by transesophageal echocardiography and CT abdominal scan revealed spleen and right kidney infarctions. Streptococcus viridans was isolated from blood cultures and was sensitive to empirical gentamycin and vancomycin. Repeated transesophageal echocardiogram (TEE) showed no residual vegetations and patient was dismissed on the 26th day with oral amoxicillin. 6 days later patient came again complaining of similar abdominal pain but with normal blood tests and no fever. Repeated CT scan revealed reinfarction of spleen and no residual changes on kidneys. TEE was preformed once again this time showing 6x6 mm floating mobile mass of the same valve highly suspicious of thrombus. Patient was dismissed after 4 days but this time with warfarin. **Conclusion**: This case reminds us of need to individualize therapy for each patient. There is perhaps underrecognized need for more liberal use of anticoagulation therapy especially in high risk patients early in the course of the disease.

Keywords

infective endocarditis, anticoagulation, bioprosthetic valve

DOI

Literature

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2. Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, et al. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J. 2015 November 21;36(44):3075–128. https://doi.org/10.1093/eurheartj/ehv319
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