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Case Report *Corresponding author
Perkel, David A, Department of Cardiology, University of Tennessee Medical Center, Knoxville, Tennessee. Septic Thrombophlebitis USA, Tel: 865-544-2800; Email: Submitted: 10 August 2016 Causing Pulmonary Valve Accepted: 07 September 2016 Published: 09 September 2016 Endocarditis and Septic Copyright © 2016 Perkel et al. Pulmonary Emboli: A Rare and OPEN ACCESS Keywords Troublesome Trifecta • Endocarditis • Septic Pulmonaay emboli Vamsee M. Lakkakula, David A. Perkel*, Jerry J Crook II, and • Catheterization Tjuan L. Overly Departments of Biology and Otolaryngology, University of Washington, USA
Abstract Pulmonic valve endocarditis is a rare entity with a prevalence of 1.5-2.0% in all cases of endocarditis. As few as 45 cases were reported in patients with structurally normal hearts between 1960 and 2005. Several cases have been reported with unique etiologies and have been seen in patients with PDA, sickle cell, Valsalva sinus aneurysm, skin infection of the hallux, VSD, and following a pulmonary artery catheterization. We present a case of septic thrombophlebitis inducing pulmonary endocarditis and septic pulmonary emboli.
CASE DESCRIPTION transgastric views. Three dimensional images were obtained in the high esophageal view showing vegetations involving the Pulmonic valve endocarditis is a rare entity with a prevalence of 1.5-2.0% in all cases of endocarditis. As few as 45 cases were with a predisposition (IVDA), fevers and vascular phenomena reported in patients with structurally normal hearts between metright the and Duke non-coronary criteria for cusps. a diagnosis The echocardiographic of infective endocarditis. findings 1960 and 2005 [1-4]. Several cases have been reported with The patient clinically improved with intravenous antibiotic unique etiologies and have been seen in patients with PDA, sickle therapy, completing a 28 day course. Surgery was deferred given cell, Valsalva sinus aneurysm, skin infection of the hallux, VSD, clinical response and likelihood of continuing intravenous drug and following a pulmonary artery catheterization [7-12]. We abuse. A transthoracic echocardiogram was performed at one present a case of septic thrombophlebitis inducing pulmonary month follow up which did not show evidence of pulmonic valve endocarditis and septic pulmonary emboli. vegetations. In addition, the pulmonic regurgitation improved A 25-year-old female with history of IV drug abuse with a from moderate to trace (Video 1). Systolic function and size of recent IV use to the left lower extremity was admitted with septic both ventricles remained normal. shock endorsing a 1-week history of fatigue, fevers, chills and left lower leg pain. Physical exam revealed a febrile, ill appearing DISCUSSION female with a split S2 and lower extremity swelling with Pulmonic valve endocarditis may go undiagnosed for some multiple ecchymoses. Broad spectrum antibiotic therapy was initiated along with intravenous vasopressors. Five temporally separated blood cultures were obtained and all were negative. timesociated due withto its left-sided often indolent endocarditis, course. Becausethe diagnosis of non-specificity of pulmonic Initial imaging showed diffuse left lower extremity deep vein valveof symptoms endocarditis and the may lack be of delayed typical forperipheral up to 6 findings months, that with as a thrombosis. CT angiogram on hospital day 2 revealed multiple mean of delay noted in one study of 65 days. [7]. Pulmonic valve septic emboli in the lungs. A three-dimensional transesophageal endocarditis is rare compared with the other cardiac valves, echocardiogram on hospital day 3 showed moderate pulmonic and usually only seen in the setting of tricuspid endocarditis valve regurgitation. Mobile densities measuring approximately [7]. Causative organisms are similar to other valves with 2 cm were seen on the pulmonic valve visualized in multiple staphylococcus aureus being the most common microorganism views. The vegetations were evident in the high esophageal and detected in blood culture. Approximately 10% of reported cases
Cite this article: Lakkakula VM, Perke DA, Crook II JJ, Overly TL (2016) Septic Thrombophlebitis Causing Pulmonary Valve Endocarditis and Septic Pulmo- nary Emboli: A Rare and Troublesome Trifecta. J Cardiol Clin Res 4(6): 1076. Perkel et al. (2016) Email:
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Cite this article Lakkakula VM, Perke DA, Crook II JJ, Overly TL (2016) Septic Thrombophlebitis Causing Pulmonary Valve Endocarditis and Septic Pulmonary Emboli: A Rare and Troublesome Trifecta. J Cardiol Clin Res 4(6): 1076.
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