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Title: Delayed diagnosis of right-sided valve endocarditis causing recurrent pulmonary abscesses: a case report
Authors: Bamford, Paul ;Soni, Rajeev ;Kull, Anthony ;Bassin, L.
Affliation: Central Coast Local Health District
Gosford Hospital
The University of Newcastle
Issue Date: Apr-2019
Source: 13(1):97
Journal title: Journal of Medical Case Reports
Department: Cardiology
Respiratory Medicine
Abstract: BACKGROUND: Pulmonary valve infective endocarditis is a rare diagnosis that is usually associated with immunocompromised states or structurally abnormal hearts. It is unusual for it to occur in structurally normal hearts or to cause recurrent symptoms after targeted antibiotics. Although guidelines suggest follow-up with repeat echocardiography and inflammatory marker surveillance, this case demonstrates that these are not always useful investigations, and instead imaging of the chest may be more appropriate. CASE PRESENTATION: We describe a case of a 74-year-old man who presented with respiratory symptoms and was originally misdiagnosed with pneumonia but later found to have a large pulmonary valve vegetation caused by Streptococcus mitis. Despite initially responding to antibiotic therapy, the vegetation continued to cause pulmonary emboli and cavitating lung abscesses months later, necessitating pulmonary valve replacement. CONCLUSIONS: This case demonstrates that pulmonary valve endocarditis can present atypically with recurrent respiratory symptoms, and in such cases, echocardiography should be considered to investigate for right-sided infective endocarditis. In addition, despite correct treatment, with normalization of inflammatory markers and improvement in vegetation size, infective endocarditis can continue to cause systemic symptoms. Finally, clinicians should consider chest computed tomography routinely as part of right-sided infective endocarditis follow-up.
DOI: 10.1186/s13256-019-2034-7
ISSN: 1752-1947
Publicaton type: Journal Article
Keywords: Cardiology
Study or Trial: Case Series and Case Reports
Appears in Collections:Cardiology

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