A rarely seen cause of prosthetic mitral valve endocarditis: Salmonella enteritidis.

Abstract

Reports of infective endocarditis due to Salmonella species are extremely rare [1]. There are only nine case reports in English medical literature on this subject till date [1–5]. Here, we report the tenth case of Salmonella prosthetic valve endocarditis. A 62-year-old woman was admitted with complaints of fever, fatigue, and lack of appetite for a duration of 2 months. Three months prior to admission, she had developed Salmonella gastroenteritis, and had been treated. She had had a mitral valve replacement operation 9 years ago with bileaflet prosthetic valve. At the time of admission she had no fever. On physical examination, a metallic valve sound was heard on the apex without any sufle and hepatomegaly was present. Laboratory tests yielded a leukocyte count of 18,600/mm, an erythrocyte sedimentation rate 131 mm/ h, an RF 54.2 IU/ml, and CRP 29.3 mg/l. A chest X-ray showed cardiomegaly. Two days after the admission her fever reached 398C. After taking blood cultures intravenous chemotherapy was administrated. In at least four of the five blood cultures Salmonella enteritidis was isolated (group D). The gaita culture was normal. There was no infection focus on abdominal sonography examination. A transesophageal echocardiography revealed a 0.8 £ 0.3 cm sized, mobile vegetation on the functional prosthetic mitral valve annulus. These findings were considered a prosthetic mitral valve endocarditis case due to Salmonella enteritidis. Cephtriaxone was continued for 6 weeks. However, because of persistent fever, and persistent vegetation image on the prosthetic mitral valve annulus, despite this treatment, operation was indicated. On operation, under open-heart surgery conditions, the prosthetic valve seemed to be functional, therefore, only the vegetation was removed. Postoperative period was uneventful. The patient was followed-up postoperatively, and no recurrence was found. Parenteral chemotherapy prompt valve replacement surgery following Salmonella endocarditis is the choice of treatment. However, the time of surgery still remains controversial [1,2]. In the diagnosed case reports with prosthetic valve endocarditis chemotherapy prompt surgery treatment had been advised [2,4]. In the present case, because of functional and stable prosthetic mitral valve without any paravalvulary infection focus, valve replacement was not considered during the operation. Only the vegetation was removed totally. Sixteen weeks after the termination of chemotherapy no signs of recurrence were observed. As a result, in the Salmonella prosthetic valve endocarditis diagnosed cases surgical treatment should be considered if fever recurrence occurs with stable hemodynamic conditions during the chemotherapy treatment.