SPLENIC INFARCTS AS THE INITIAL MANIFESTATION OF NATIVE VALVE ENDOCARDITIS CAUSED BY STREPTOCOCCUS DYSGALACTIAE

ABSTRACT

SESSION TITLE COVID-19 Case Report Posters 1 SESSION TYPE Case Report Posters PRESENTED ON 10/17/2022 1215 pm - 0115 pm INTRODUCTION: We describe the clinical course of a COVID-19 patient with Streptococcus Dysgalactiae (SD) infective endocarditis, managed with six weeks of antibiotics and valve replacement surgery. CASE PRESENTATION A 50-year-old previously healthy man presented with two weeks of fever, congestion, and diarrhea, and one day of acute change in mentation. On arrival, the patient's heart rate was 130/min, respiratory rate 25/min, and temperature 103.5 F. On physical examination, he appeared lethargic. Initial labs showed a white blood count of 16 k/mm with bands and platelets of 64 k/cmm. The patient was treated empirically for severe sepsis with intravenous vancomycin and cefepime. Blood cultures grew SD. Antibiotics were narrowed to intravenous ceftriaxone. A CAT scan of the chest, abdomen, and pelvis identified multiple splenic infarcts. A transesophageal echocardiogram was performed to evaluate the potential source of the splenic emboli, and this showed mild to moderate mitral regurgitation and a large globular mobile vegetation on the anterior mitral valve. Intravenous gentamicin was added to the treatment regimen. Subsequent cultures remained negative, and he underwent bioprosthetic mitral valve replacement on hospital day 11. He received a total of 6 weeks of outpatient intravenous antibiotic therapy. DISCUSSION: SD is a normal commensal of the skin, upper airway, and gastrointestinal tract. It can cause localized and invasive infections. Major risk factors for invasive infections include malignancy, diabetes mellites, and other cardiovascular diseases. Besides a recent COVID-19 infection, our patient was healthy. The COVID-19 infection causes a hypercoagulable state, and when combined with COVID-19 related diarrhea, can lead to the translocation of the gut bacteria, and subsequent infective endocarditis (IE) [1]. SD is a rare cause of IE, but the incidence of IE in bacteremic patients is about 10% [2]. Clinicians should have a low threshold to suspect IE in cases of SD bacteremia. American Heart Association Guidelines on IE [3] state that systemic embolization occurs in 22% to 50% of cases of IE, and the highest incidence of embolism occurs when the vegetation is mobile, on the anterior mitral valve and > 10 mm, like in our case. In such patients, early cardiac surgery should be considered. SD bacteremia recurrence occurs in about 10% of patients within the first year, and patients should be informed about this risk. CONCLUSIONS: Clinicians should suspect IE in the setting of SD bacteremia. COVID-19 infection increases the chances of the development of infective endocarditis. Prolonged intravenous antibiotic therapy and prompt replacement of the involved valve is necessary. SD IE is associated with a high rate of recurrence, and clinicians should be cognizant of this risk. Reference #1 "COVID-19 INFECTION PREDISPOSING ENDOCARDITIS ….” https//www.scienceopen.com/document?vid=02f2bbbe-479d-4d11-ad60-2ceba336a4e1. Accessed 4 Apr. 2022. Reference #2 "Bacteremia caused by group G Streptococci, taiwan - PubMed.” https//pubmed.ncbi.nlm.nih.gov/18439377/. Accessed 4 Apr. 2022. Reference #3 "Clinical relevance of vegetation localization by … - Semantic Scholar.” https//www.semanticscholar.org/paper/Clinical-relevance-of-vegetation-localization-by-in-Rohmann-Erbel/0106e26e3f2102eb6dd2fd7e086210c0a44ebf45. Accessed 4 Apr. 2022. DISCLOSURES No relevant relationships by Husam Bader No relevant relationships by Poorva Bhide No relevant relationships by Gaurav Mohan No relevant relationships by Muhammad Tayyeb No relevant relationships by Charmee Vyas No relevant relationships by Siva Naga Yarrarapu