AN UNUSUAL CASE OF TRICUSPID VALVE INFECTIVE ENDOCARDITIS CAUSED BY ERYSIPELOTHRIX RHUSIOPATHIAE

Abstract

SESSION TITLE: Medical Student/Resident Cardiovascular Disease Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Erysipelothrix rhusiopathiae is an uncommon cause of endocarditis. We present a case of Erysipelothrix rhusiopathiae in a patient with tricuspid valve involvement. CASE PRESENTATION: This is a 47-year-old male with a history of hypertension who presented with a four-week history of bilateral lower extremity edema. The patient is a lumberjack by occupation and was having difficulty working. His swelling extended to his knees, prompting a visit to his primary physician. The patient was started on oral furosemide but reported no improvement. On admission, the patient was afebrile. The patient was fluid overloaded with bibasilar lung crackles and 3+ pitting edema in bilateral lower extremities. Labs revealed leucocytosis, creatinine of 3.8, and an NT-pro-BNP level of 29,959. CT of the chest revealed pulmonary edema. The patient was started on intravenous diuretic therapy and oral beta-blockers in view of his acute decompensated heart failure. The patient's blood cultures were positive for gram-positive rods and started on empiric treatment with intravenous vancomycin. Echocardiogram revealed severe tricuspid regurgitation and multiple tricuspid valve vegetations. The most significant vegetation was noted to be 2.6 cm x 1.6 cm in size. A trans-esophageal echocardiogram revealed severe tricuspid regurgitation with significant vegetations visible on all three leaflets of the tricuspid valve. After 6 days, repeat blood cultures showed gram-positive rods with sensitivities revealing Erysipelothrix rhusiopathiae as the causative agent. The patient's antibiotic regimen was converted to intravenous Penicillin G. DISCUSSION: Erysipelothrix rhusiopathiae is a gram-positive, rod-shaped, non-sporing bacillus. It is a zoonotic disease known for its association with occupations involving close exposure to animals [1]. Patients who are diagnosed with this infection manifest with skin infections or systemic organ involvement. Our patient presented with systemic bacteremia, with common involvement of the aortic valve [1]. The clinical presentation of our patient was unique, given that in the absence of heart disease, he presented with overt volume overload and acute renal failure. He lacked the more classic symptoms of infective endocarditis, including fever, chills, and skin lesions. Our patient did not have any significant past medical conditions increasing his risk for infective endocarditis. In past literature, reported cases of Erysipelothrix rhusiopathiae and endocarditis had shown a proclivity towards the aortic valve [1,2]. In our case, we felt the most astonishing feature was the isolated involvement of the tricuspid valve. Its mortality rate is higher when compared to the more common etiological pathogens of infective endocarditis [1]. CONCLUSIONS: Physicians should not only observe clinical symptoms but aim to holistically assess the patient to reach a timely diagnosis and initiate appropriate therapy. Reference #1: Reboli, A.C. and W. Farrar, Erysipelothrix rhusiopathiae. Principles and practice of infectious diseases, 2010. 5: p. 2226-7. Reference #2: Veraldi, S., et al., Erysipeloid: a review. Clinical and Experimental Dermatology: Clinical dermatology, 2009. 34(8): p. 859-862. DISCLOSURES: No relevant relationships by Karthik Gonuguntla, source=Web Response No relevant relationships by Pranav Karambelkar, source=Web Response No relevant relationships by Shivaraj Patil, source=Web Response No relevant relationships by Chaitanya Rojulpote, source=Web Response