Abstract
Background. Isolated tricuspid valve endocarditis in the absence of risk factors in the community setting is very rare and can be easily missed in patients with hitherto normal valves. Case Presentation. We present a case of a 49 year old gentleman who presented with generalized body aches, fever, and jaundice and was initial diagnosed as hepatitis. He subsequently developed recurrent episodes of panic attacks and shortness of breath and later multiple skin abscesses. Further investigations excluded pulmonary embolism but revealed multiple abscesses in the body including the lungs. Blood cultures and culture from abscesses grew S. aureus. An initial transthoracic echocardiogram was normal. A transesophageal echocardiogram subsequently confirmed endocarditis on a normal natural tricuspid valve and multiple lung abscesses. He was successfully treated with appropriate antibiotics. Conclusion. We discuss the pathogenesis of this patient's presentation highlight the need for assessment and proper evaluation of patients with unexplained bacteremia.
Highlights
Staphylococcus aureus is an important cause of communityacquired bacteremia and is associated with substantial morbidity and mortality [1,2,3]
The overall incidence of involvement of the tricuspid valve in patients with infective endocarditis is in the range of 5% to 10%, with up to 80% of tricuspid valve endocarditis occurring in drug addicts [11]
Infection of the right heart valves appears in 5%–10% of all cases and is almost always associated with intravenous drug abuse, with more than 80% of tricuspid valve endocarditis cases occurring in drug addicts [27]
Summary
Isolated tricuspid valve endocarditis in the absence of risk factors in the community setting is very rare and can be missed in patients with hitherto normal valves. We present a case of a 49 year old gentleman who presented with generalized body aches, fever, and jaundice and was initial diagnosed as hepatitis. He subsequently developed recurrent episodes of panic attacks and shortness of breath and later multiple skin abscesses. A transesophageal echocardiogram subsequently confirmed endocarditis on a normal natural tricuspid valve and multiple lung abscesses. He was successfully treated with appropriate antibiotics. We discuss the pathogenesis of this patient’s presentation highlight the need for assessment and proper evaluation of patients with unexplained bacteremia
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