Achromobacter Xylosoxidans Late-onset Prosthetic Mitral Valve Infective Endocarditis: A Case Report

Abstract

This is the case of a 35-year-old Filipino female who presented to the Philippine General Hospital with a chief complaint of fever. Two weeks prior to admission, she experienced high-grade fever (39 degrees Celsius) accompanied by chills, anorexia, and easy fatigability. A few hours prior to admission, she complained of slurred speech, right upper and right lower extremity weakness, and high-grade fever. She was diagnosed with rheumatic heart disease in the past, with mitral stenosis, and atrial fibrillation. She has undergone prosthetic mitral valve replacement. She denies intravenous drug use. On examination, she was awake, with stable vital signs and a body temperature of 39 degrees Celsius. Auscultation revealed an irregular heart rhythm, metallic S1, accentuated S2, and a 3/6 systolic murmur at the fourth left paqrasternal border. Motor strength was normal. She had leukocytosis (11.6 X 109 cells/L)þ and nromal coagulation profile. Transthoracic echocardiography revealed a dilated left atrium, a prosthetic mitral valve with good opening and closing motion, and a 0.2 x 0.4 cm oscillating mass in the ventricular aspect of the mitral valve. Blood cultures revealed Achromobacter xylosoxidans sensitive to piperacillina-tazobactam, co-trimoxazole, and ciprofloxacin. Piperacillin-tazobactam 4.5 g IV every 8 hrs and co-trimoxazole 800/160, 1 tab po every 8 hrs were given; however, due to resulting leukopenia, ciprofloxacin 500 mg/tab 1 ½ tab po q 12 hrs was substituted. Surveillance blood cultures were all negative. A follow-up transesophageal echocardiography revealed a prosthetic mitral valve with good opening and closing motion with no vegetations seen. CONCLUSION: A xylosoxidans is a rare human pathogen and causes invasive disease such as infective endocarditis in immunocompromised and debilitated patients resulting in high mortality. Prompt and effective use of antimicrobials improves survival, but removal of prostheses may be considered in the presence of unresponsive or recurrent infection. KEYWORDS: Achromobacter xylosoxidans, prosthetic valve, infective endocarditis