Abstract
Haemophilus parainfluenzae, which uncommonly causes endocarditis, has never been documented to cause mural involvement. A 62-year-old immunocompetent female without predisposing risk factors for endocarditis except for poor dentition presented with fever, emesis, and dysmetria. Echocardiography found a mass attached to the left ventricular wall with finger-like projections. Computed tomography showed evidence of embolic phenomena to the brain, kidneys, spleen, and colon. Cardiac MRI revealed involvement of the chordae tendineae of the anterior papillary muscles. Blood cultures grew Haemophilus parainfluenzae. The patient was treated successfully with ceftriaxone with resolution of symptoms, including neurologic deficits. After eleven days of antibiotics a worsening holosystolic murmur was discovered. Worsening mitral regurgitation on echocardiography was only found three weeks later. Nine weeks after presentation, intraoperative evaluation revealed chord rupture but no residual vegetation and mitral repair was performed. Four weeks after surgery, the patient was back to her baseline. This case illustrates the ability of Haemophilus parainfluenzae to form large mural vegetations with high propensity of embolization in otherwise normal cardiac tissue among patients with dental risk factors. It also underscores the importance of physical examination in establishing a diagnosis of endocarditis and monitoring for progression of disease.
Highlights
Endocarditis is a rare but serious infection with hospital mortality averaging 18% but dependent upon causative pathogen, lesion type, and patient comorbidities [1]
Staphylococcus aureus and streptococci are the most common causes of mural endocarditis, whereas mural endocarditis from the HACEK organisms (Haemophilus species, Aggregatibacter species, Cardiobacterium hominis, Eikenella corrodens, and Kingella species) has not been reported [2, 3], even though 1.4% of total endocarditis cases are attributed to HACEK organisms [4]
Haemophilus parainfluenzae is an uncommon cause of endocarditis that affects patients with poor dentition and causes large vegetations with a high propensity for embolization
Summary
Endocarditis is a rare but serious infection with hospital mortality averaging 18% but dependent upon causative pathogen, lesion type, and patient comorbidities [1]. Seen in 4% of cases of endocarditis, is defined as inflammation of the nonvalvular endocardial surface in any of the four chambers of the heart [2]. It is thought to arise from seeding of either congenitally or iatrogenically abnormal endocardium. Staphylococcus aureus and streptococci are the most common causes of mural endocarditis, whereas mural endocarditis from the HACEK organisms (Haemophilus species, Aggregatibacter species, Cardiobacterium hominis, Eikenella corrodens, and Kingella species) has not been reported [2, 3], even though 1.4% of total endocarditis cases are attributed to HACEK organisms [4]
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