Recurrent infective endocarditis with mycotic aneurysm - Imaging modalities for the detection of an infective focus

Staphylococcus aureus bacteremia (SAB) and infective endocarditis (IE) are infections associated with considerable morbidity, requiring prompt accurate diagnosis and treatment. We present a case of a 58-year-old male patient with four episodes of recurrent symptomatic SAB treated for IE, but without...

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Bibliographic Details
Published in:Heart views 2020-10, Vol.21 (4), p.300-304
Main Authors: Han, Jennie, Okonkwo, Kenneth, Attar, Nadeem
Format: Article
Language:English
Subjects:
Aneurysms
Care and treatment
Case Report
CT imaging
Endocarditis
Health aspects
Infection
Infective endocarditis
PET imaging
Staphylococcus aureus
Staphylococcus aureus infections
Tomography
Type 2 diabetes
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Summary:Staphylococcus aureus bacteremia (SAB) and infective endocarditis (IE) are infections associated with considerable morbidity, requiring prompt accurate diagnosis and treatment. We present a case of a 58-year-old male patient with four episodes of recurrent symptomatic SAB treated for IE, but without positive findings on transthoracic echocardiography, transesophageal echocardiography, and fluorodeoxyglucose-positron emission tomography (FDG-PET). On the last admission, FDG-PET showed increased uptake in the right atrial appendage, and white blood cell single-photon emission computerized tomography (WBC-SPECT) was able to identify the infective focus as IE of the aortic valve. CT of the thorax also identified an associated mycotic aneurysm of the right coronary sinus. He was subsequently treated with mechanical aortic prosthesis and right coronary sinus plasty, and his symptoms did not recur till 2 years postcardiothoracic surgery. This case report demonstrates the emergence of nuclear cardiovascular imaging modalities in the diagnostic workup of IE and the utility of FDG-PET and WBC-SPECT in the identification of the infective focus. Patients with possible IE from the modified Duke criteria should be considered for FDG-PET or WBC-SPECT to enhance sensitivity. Peripheral mycotic aneurysms are a common complication of left-sided IE, which can present late into the disease process, and aortic imaging should be considered in patients with recurrent endocarditis to identify this.
ISSN:1995-705X
0976-5123
DOI:10.4103/HEARTVIEWS.HEARTVIEWS_69_20