Monoarthritis as first manifestation of Streptococcus sanguis endocarditis on bicuspid aortic and mitral valve – case report

    Authors

    Keywords

    infective endocarditis, monoarthritis, bicuspid aortic valve, Streptococcus sanguis

    DOI

    https://doi.org/10.15836/ccar2016.507

    Full Text

    **Introduction**: Infective endocarditis (IE) is a life-threatening disease of the heart valves that despite modern therapeutic options has a poor prognosis and high mortality. IE occurs more often in patients with acquired or congenital heart disease, and the etiology is usual bacterial. Echocardiography has the key role in establishing the diagnosis. Given the different, often atypical forms of presentation, this complex infectious disease still represents a diagnostic challenge despite the progress of clinical practice. (1-5) **Case report**: 47-year-old patient with quarterly intermittent fever and pain in the right hip, was hospitalized becomes because of dry cough and breathlessness at minimal effort that occurred few days before admission. Two months earlier, the patient was treated at the Clinic for Orthopaedic Surgery due to synovitis of the right hip. The emergency echocardiography showed endocarditis of the bicuspid aortic valve with severe aortic and mitral regurgitation. Transesophageal ultrasound demonstrated a paravalvular abscess of the aortic valve that was expanding forward the base of the anterior mitral leaflet. With administration of empirical antibiotic therapy, and after hemodynamic stabilization, the patient underwent emergency cardiothoracic surgery. The biological aortic and mitral valve were successfully implanted. From later received blood cultures, Streptococcus sanguis was isolated. **Conclusion**: IE may have a number of different and often atypical clinical presentations. In every prolonged febrile disease course, we should think on IE. Febrile inflammation of the musculoskeletal system of unknown etiology may represent the first manifestation of IE. Patients with congenital heart disease such as bicuspid aortic valve, are at particular risk for the development of IE. Although in this case the bicuspid aortic valve represents a predisposition for the development of IE, the fact that the Streptococcus sanguis endocarditis is more frequently in patients with malignant and inflammatory gastrointestinal diseases bring us to the question on subsequent gastrointestinal treatment in the present case.

    Literature

    1. 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;36(44):3075–128. https://doi.org/10.1093/eurheartj/ehv319
    2. Doube A, Calin A. Bacterial endocarditis presenting as acute monoarthritis. Ann Rheum Dis. 1988;47:598–9. https://doi.org/10.1136/ard.47.7.598
    3. Nijjer S, Dubrey SW. Streptococcus sanguis endocarditis associated with colonic carcinoma. BMJ Case Rep. 2010;2010:bcr09.2009.2311. https://doi.org/10.1136/bcr.09.2009.2311
    4. Cognasse F, Hamzeh-Cognasse H, Chabert A, Jackson E, Arthaud CA, Garraud O, et al. Streptococcus sanguinis-induced cytokine and matrix metalloproteinase-1 release. BMC Immunol. 2014 Apr 22;15:15. https://doi.org/10.1186/1471-2172-15-15
    5. Crump KE, Bainbridge B, Brusko S, Turner LS, Ge X, Stone V, et al. The relationship of the lipoprotein SsaB, manganase and superoxide dismutase in Streptococcus sanguinis virulence for endocarditis. Mol Microbiol. 2014;92(6):1243–59. https://doi.org/10.1111/mmi.12625
    Cardiologia Croatica
    Back to search

    Monoarthritis as first manifestation of Streptococcus sanguis endocarditis on bicuspid aortic and mitral valve – case report

    Extended Abstract
    Issue10-11
    Published
    Pages507
    PDF via DOIhttps://doi.org/10.15836/ccar2016.507
    infective endocarditis
    monoarthritis
    bicuspid aortic valve
    Streptococcus sanguis

    Authors

    Rina Dalmatin*ORCIDPula General Hospital, Pula, Croatia
    Davorka LulićORCIDUniversity of Rijeka School of Medicine, University Hospital Centre Rijeka, Rijeka, Croatia
    Gordan GulanORCIDClinic for Orthopaedic Surgery “Lovran”, Rijeka, CroatiaLovran, Croatia
    Luka ZaputovićORCIDUniversity of Rijeka School of Medicine, University Hospital Centre Rijeka, Rijeka, Croatia
    Alen RužićORCIDUniversity of Rijeka School of Medicine, University Hospital Centre Rijeka, Rijeka, Croatia

    *Correspondence email: rina.dalmatin@gmail.com

    Full Text

    Introduction: Infective endocarditis (IE) is a life-threatening disease of the heart valves that despite modern therapeutic options has a poor prognosis and high mortality. IE occurs more often in patients with acquired or congenital heart disease, and the etiology is usual bacterial. Echocardiography has the key role in establishing the diagnosis. Given the different, often atypical forms of presentation, this complex infectious disease still represents a diagnostic challenge despite the progress of clinical practice. (1–5)

    Case report: 47-year-old patient with quarterly intermittent fever and pain in the right hip, was hospitalized becomes because of dry cough and breathlessness at minimal effort that occurred few days before admission. Two months earlier, the patient was treated at the Clinic for Orthopaedic Surgery due to synovitis of the right hip. The emergency echocardiography showed endocarditis of the bicuspid aortic valve with severe aortic and mitral regurgitation. Transesophageal ultrasound demonstrated a paravalvular abscess of the aortic valve that was expanding forward the base of the anterior mitral leaflet. With administration of empirical antibiotic therapy, and after hemodynamic stabilization, the patient underwent emergency cardiothoracic surgery. The biological aortic and mitral valve were successfully implanted. From later received blood cultures, Streptococcus sanguis was isolated.

    Conclusion: IE may have a number of different and often atypical clinical presentations. In every prolonged febrile disease course, we should think on IE. Febrile inflammation of the musculoskeletal system of unknown etiology may represent the first manifestation of IE. Patients with congenital heart disease such as bicuspid aortic valve, are at particular risk for the development of IE. Although in this case the bicuspid aortic valve represents a predisposition for the development of IE, the fact that the Streptococcus sanguis endocarditis is more frequently in patients with malignant and inflammatory gastrointestinal diseases bring us to the question on subsequent gastrointestinal treatment in the present case.

    Literature

    1. 1.
      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;36(44):3075–128.DOI
    2. 2.
      Doube A, Calin A. Bacterial endocarditis presenting as acute monoarthritis. Ann Rheum Dis. 1988;47:598–9.DOI
    3. 3.
      Nijjer S, Dubrey SW. Streptococcus sanguis endocarditis associated with colonic carcinoma. BMJ Case Rep. 2010;2010:bcr09.2009.2311.DOI
    4. 4.
      Cognasse F, Hamzeh-Cognasse H, Chabert A, Jackson E, Arthaud CA, Garraud O, et al. Streptococcus sanguinis-induced cytokine and matrix metalloproteinase-1 release. BMC Immunol. 2014 Apr 22;15:15.DOI
    5. 5.
      Crump KE, Bainbridge B, Brusko S, Turner LS, Ge X, Stone V, et al. The relationship of the lipoprotein SsaB, manganase and superoxide dismutase in Streptococcus sanguinis virulence for endocarditis. Mol Microbiol. 2014;92(6):1243–59.DOI