Infective Endocarditis From Pseudomonas aeruginosa and Group C Streptococcus

First Author(s)

• 

  Abhinandan Chittal

  MedStar Union Memorial Hospital
  Baltimore, MD

  Disclosure information not submitted.

  Slides and Audio

Co-Author(s)

• SR

  Shiavax Rao, MD,

  Resident Physician
  n/a, United States

  Disclosure information not submitted.
• PL

  Pallavi Lakra, MBBS

  Resident Physician
  MedStar Health, United States

  Disclosure information not submitted.
• HC

  Hitesh Chawla, MD

  Physician
  MedStar Heart & Vascular Institute, Baltimore, United States

  Disclosure information not submitted.

Title: Infective Endocarditis from Pseudomonas aeruginosa and Group C Streptococcus
Case Report Body:

Introduction: Infective endocarditis (IE) refers to infection of the endocardium, usually affecting the heart valves. Organisms commonly causing IE include S. aureus, S. viridans, HACEK group organisms. Group C Streptococcus infections are mainly described in domesticated animals, with infections in humans being rare. IE from P. aeruginosa is also rare, and associated with a high mortality and morbidity. We present a complex clinical case of a woman with Group C Streptococcus and P. aeruginosa endocarditis, complicated by septic pulmonary emboli and a septic embolic stroke.

Description: A 34-year-old woman with a history of intravenous heroin use presented with progressively worsening dyspnea, lethargy and right leg swelling for 2 weeks. She had previously presented with a right leg ulcer but had refused hospitalization at the time. Physical examination was remarkable for a soft systolic murmur in the tricuspid region and a 10x10 cm necrotic wound on the right lower extremity. Laboratory diagnostics revealed leukocytosis with neutrophilia, anemia, thrombocytopenia and elevated creatinine. Serial blood cultures grew P. aeruginosa and group C Streptococcus. An echocardiogram revealed multiple echodense masses on the tricuspid valve with severe tricuspid regurgitation, along with a < 1 cm echodensity on the noncoronary cusp of the aortic valve, highly concerning for vegetations. She was treated with cefepime, covering both organisms, and cardiac surgery was consulted for valve replacement. The hospital course was complicated by embolic strokes in multiple cortical territories, surgery was deferred and the patient left the hospital against medical advice. Subsequently, she has had multiple admissions with renal failure and septic pulmonary emboli and remains to have residual right sided paresis.

Discussion: P. aeruginosa and Group C Streptococcus are both rare causes of endocarditis, mostly associated with intravenous drug use, with significant morbidity and mortality. We describe a clinical case of polymicrobial endocarditis with rare pathogens, complicated by renal failure, septic pulmonary emboli and stroke. Prompt recognition with appropriate diagnostics in such patients can lead to early intervention and improve patient outcomes.