P1244 Mitral valve abscess caused by Klebsiella pneumoniae in a patient with diabetes melitus

Abstract

Abstract Introduction Infective endocarditis (IE) still leads to high mortality, despite the achievements of modern medicine. Particular attention should be paid to the group of patients in whom the occurence of IE is caused by rare atypical bacteria, such as Klebsiella pneumoniae. It is known that Klebsiella is the cause of IE in only 1.2% of cases in patients with native valves (Anderson MJ, Janoff EN, 1998), at the same time disease proceeds extremely aggressive. Case presentation Patient M., 47 years old, complained of shortness of breath, fever up to 40 degrees Celcius and general weakness. In medical history patient had diabetes melitus (DM) for a 15 years. 10 days before hospitalization the patient was subjected to hypothermia, after that he noted the appearance of fever, chills and general weakness. 4 days after the symptoms appears he turned to a general practitioner and was diagnosed with acute respiratory viral infection. Since the patient did not notice the effect of treatment for 5 days (general weakness and fever persisted, shortness of breath appeared), he called an ambulance and was taken to our clinic with suspected pneumonia. Conducted computer tomography (CT) revealed no signs of pneumonia. During hospitalization, transthoracic echocardiography (TTE) was performed. There was no heart disease in the patient"s medical history. TTE revealed the hyperechoic mobile mass (15x15 mm) on the posterior cusp of a mitral valve. Mitral regurgitation was within physiological range. For the verification, patient was recommended to undergo transesophageal echocardiography (TEE), but he categorically refused this examination. Against the background of ongoing antibiotic therapy fever persisted. Subsequently, the patient was consulted by a neurologist about a complaint of double vision, and a brain CT was performed and revealed acute infarction in the right occipital lobe. Stroke was regarded as cardioembolic. The patient"s condition progressively worsened, miltiple organ failure was increasing, he was intubated and transferred to the intensive care unit. We performed an ultrasound as heart murmur appeared. TEE revealed a large hyperechoic formation 30x30 mm with anechoic collapsing cavity in the center and defect in the posterior cusp up to 20 mm, mitral regurgitation reached 4 degrees. Despite adequate therapy the patient"s condition progressively worsened, and the next morning biological death was diagnosed. The autopsy results confirmed IE caused by Klebsiella pneuminiae. Conclusion Our clinical case shows that we cannot neglect a small percentage of cases of IE caused by such atypical bacteria as Klebsiella. The disease in this case was extremely severe and difficult to treat, which can be explained by the tendency of patients with DM to the occurence of infections. Abstract P1244 Figure.