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Native triple-valve endocarditis caused by penicillin-resistant Streptococcus sanguis

Nature Clinical Practice Cardiovascular Medicine volume 4, pages 340–343 (2007)Cite this article

Abstract

Background A 26-year-old man with known but untreated ventricular septal defect was admitted to the emergency ward with abdominal pain, fever and weight loss. Transthoracic echocardiography showed multiple vegetations on the anterior mitral leaflet, a mobile vegetation on the surface of the aortic noncoronary cusp and another on the tricuspid valve. His blood cultures grew Streptococcus sanguis with a penicillin minimum inhibitory concentration of 3 µg/ml.

Investigations Physical examination, echocardiography, blood cultures, minimal inhibitory concentration detection.

Diagnosis Multivalvular infective endocarditis caused by S. sanguis with a high penicillin resistance.

Management A combination of intravenous vancomycin and gentamicin, followed by early surgery.

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Figure 1: Transthoracic echocardiogram during diastole (parasternal long axis view), showing multiple vegetations on the anterior leaflet of the patient's mitral valve (arrows 1 and 2) and a 16 × 6 mm mobile vegetation on the aortic noncoronary cusp (arrow 3)
Figure 2: M-mode echocardiogram of the patient's mitral valve, showing multiple echoes from vegetations on the anterior leaflet during diastole

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Authors and Affiliations

  1. and A Tunckale is Professor of Medicine and Director of the Emergency Department of Internal Medicine, M Yilmaz is a Fellow and F Tabak is Professor of Medicine in the Department of Infectious Diseases and Clinical Microbiology, I Bavunoglu is Associate Professor, S Sahin and T Toptas are Residents, Cerrahpasa Medical Faculty, University of Istanbul, Turkey.,

    Isil Bavunoglu, Serap Sahin, Mesut Yilmaz, Tayfur Toptas, Fehmi Tabak & Aydin Tunckale

Authors
  1. Isil Bavunoglu
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  2. Serap Sahin
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Correspondence to Isil Bavunoglu.

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The authors declare no competing financial interests.

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Bavunoglu, I., Sahin, S., Yilmaz, M. et al. Native triple-valve endocarditis caused by penicillin-resistant Streptococcus sanguis. Nat Rev Cardiol 4, 340–343 (2007). https://doi.org/10.1038/ncpcardio0906

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