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Toda E, Kajiya T, Higo K, Ito K, Ueno M, Takaoka J, Atsuchi Y, Atsuchi N, Ohishi M. Association of infective endocarditis caused by Abiotrophia defectiva with mycotic aneurysm formation: A case report and the review of the literature. J Cardiol Cases 2023; 28:161-163. [PMID: 37818438 PMCID: PMC10562086 DOI: 10.1016/j.jccase.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 05/13/2023] [Accepted: 05/23/2023] [Indexed: 10/12/2023] Open
Abstract
A 74-year-old woman with a history of mitral valve prolapse with mitral regurgitation was transferred to our hospital due to infective endocarditis. Blood culture revealed Abiotrophia defectiva which is known as a nutritional variant streptococcus. Transesophageal echocardiography revealed posterior leaflet (P2) prolapse due to rupture of tendon chordae with severe mitral regurgitation and vegetation on posterior leaflet. Magnetic resonance imaging (MRI) revealed multiple infarction lesions in left temporal lobe and parietal lobe and mycotic aneurysm formation of right middle cerebral artery. Because A. defectiva cannot be cultured on non-supplemented media, their prevalence may be underreported. Learning objective A number of causative microorganisms of infective endocarditis have been identified. Streptococci and staphylococci account for 80 % of cases of infective endocarditis. Abiotrophia defectiva does not grow in ordinary growth media and its prevalence may be underreported. It is important to know A. defectiva causes infective endocarditis with mycotic aneurysm formation.
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Affiliation(s)
- Erisa Toda
- Department of Cardiology, Tenyoukai Central Hospital, Kagoshima, Japan
| | - Takashi Kajiya
- Department of Cardiology, Tenyoukai Central Hospital, Kagoshima, Japan
| | | | - Kanae Ito
- Imamura General Hospital, Kagoshima, Japan
| | - Masahiro Ueno
- Department of Cardiovascular Surgery, Tenyoukai Central Hospital, Kagoshima, Japan
| | - Junichiro Takaoka
- Department of Cardiology, Tenyoukai Central Hospital, Kagoshima, Japan
| | - Yoshihiko Atsuchi
- Department of Cardiology, Tenyoukai Central Hospital, Kagoshima, Japan
| | - Nobuhiko Atsuchi
- Department of Cardiology, Tenyoukai Central Hospital, Kagoshima, Japan
| | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Kagoshima University, Kagoshima, Japan
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Moroșan D, Șerban A, Trifan C, Encica S, Pop S, Șerban TC, Rednic S, Damian L. Frenemies within: An Endocarditis Case in Behçet's Disease. J Pers Med 2021; 11:728. [PMID: 34442371 PMCID: PMC8402229 DOI: 10.3390/jpm11080728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/14/2021] [Accepted: 07/25/2021] [Indexed: 01/05/2023] Open
Abstract
A 57-year female patient diagnosed with Behçet's disease, on azathioprine, was noticed to have at a routine examination antinuclear and antiphospholipid antibodies. An overlapping lupus-like syndrome was diagnosed; hydroxychloroquine and aspirin were added. Three years later, the patient presented with dyspnea and sweating, with no fever. A cardiac bruit was noted; a giant vegetation was detected by echocardiography. Laboratory revealed severe thrombocytopenia, antiphospholipid antibodies and low complement. Blood cultures were positive for Abiotrophia defectiva serology and also revealed a chronic Coxiella burnetii infection. Antibiotic therapy, low-dose anticoagulation and control of the underlying disease mildly improved the platelet count, which fully recovered only after cardiac valve replacement. However, the Behçet's disease, initially quiescent, flared after the therapy of infections. We discuss potential links between Behçet's disease and the occurrence of antinuclear and antiphospholipid antibodies and Coxiella endocarditis in this setting. We also highlight the differences between the endocarditis in Behçet's disease, antiphospholipid syndrome, Coxiella burnetii and Abiotrophia defectiva infection, respectively. Intracellular infections may modify the presentation of autoimmune diseases. Confounding clinical features of Coxiella persistent infection and non-bacterial thrombotic endocarditis in Behçet's disease warrant further insight.
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Affiliation(s)
- Diana Moroșan
- Department of Rheumatology, “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, 8 Victor Babeș St., 400012 Cluj-Napoca, Romania; (D.M.); (S.R.)
| | - Adela Șerban
- Department of Cardiology, “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, 8 Victor Babeș St., 400012 Cluj-Napoca, Romania;
- Department of Cardiology, “Niculae Stancioiu” Heart Institute Cluj-Napoca, 19-21, Calea Moților St., 400001 Cluj-Napoca, Romania;
| | - Cătălin Trifan
- Department of Cardiovascular Surgery, “Niculae Stancioiu” Heart Institute Cluj-Napoca, 19-21, Calea Moților St., 400001 Cluj-Napoca, Romania;
| | - Svetlana Encica
- Department of Pathology, “Niculae Stancioiu” Heart Institute Cluj-Napoca, 19-21, Calea Moților St., 400001 Cluj-Napoca, Romania
| | - Sorin Pop
- 1st Internal Medicine Department, Emergency Clinical County Hospital Cluj, 3-5 Clinicilor St., 400006 Cluj-Napoca, Romania;
| | - Tudor Costinel Șerban
- Department of Cardiology, “Niculae Stancioiu” Heart Institute Cluj-Napoca, 19-21, Calea Moților St., 400001 Cluj-Napoca, Romania;
| | - Simona Rednic
- Department of Rheumatology, “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, 8 Victor Babeș St., 400012 Cluj-Napoca, Romania; (D.M.); (S.R.)
- Department of Rheumatology, Centre for Rare Musculoskeletal Autoimmune and Autoinflammatory Diseases, Emergency Clinical County Hospital Cluj, 2-4 Clinicilor St., 400006 Cluj-Napoca, Romania;
| | - Laura Damian
- Department of Rheumatology, Centre for Rare Musculoskeletal Autoimmune and Autoinflammatory Diseases, Emergency Clinical County Hospital Cluj, 2-4 Clinicilor St., 400006 Cluj-Napoca, Romania;
- CMI Reumatologie Dr. Damian, 6-8 P. Maior St., 400002 Cluj-Napoca, Romania
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