Rare cause of complicated prosthetic valve endocarditis

Excerpt

A 29-year-old gentleman, employed in an animal farm, presented with a 6-month history of chronic fever, anorexia, and malaise. He had undergone aortic valve replacement with mechanical prosthesis for severe aortic stenosis due to bicuspid aortic valve at the age of 25. Clinical examination showed a normal jugular pulse, absence of cardiomegaly, normal prosthetic valve clicks, grade 3 ejection systolic murmur in the right second parasternal space, and non-tender hepatosplenomegaly. Labortory examination showed hemoglobin – 15.9 g/dl and a total count of 4900 cells/mm³ with a differential count of 49% polymorphs and 48% lymphocytes. Electrocardiogram showed a normal sinus rhythm with a PR interval of 150 ms. Echocardiography, transthoracic (Fig. 1a, Video 1), transesophageal (Fig. 1b, Video 2), and 3D (Fig. 1c, d, Video 3), revealed multiloculated aortic root abscess encircling the prosthetic valve. Blood culture grew Brucella melitensis in three consecutive samples and the same was confirmed by reverse transcriptase-polymerase chain reaction (RT PCR). Computed tomography (Figs. 2, 3, and 4) showed multiple outpouchings from the aortic root in close proximity to the valve. He has been initiated on treatment with rifampicin, doxycycline, cotrimoxazole, and streptomycin and is planned for aortic root replacement.

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