Tricuspid valve endocarditis with septic pulmonary embolism following induced abortion in an immunocompetent patient: A case report

Abstract

Infective endocarditis (IE) is a life-threatening disease where infections most commonly involve heart valves but may occur at the site of a septal defect or chordate tendinea or on the mural endocardium. Infection of arteriovenous shunts, arterioarterial shunts (patent ductus arteriosus), or coarctation of the infective aorta are clinically and pathologically similar to IE. Conditions predisposing to native valve endocarditis are rheumatic heart disease (where the mitral valve is frequently involved followed by the aortic valve), congenital heart disease (commonly patent ductus arteriosus, ventricular septal defect, and bicuspid aortic valve), and intravenous (IV) drug abusers [tricuspid valve (TV) commonly involved followed by the mitral valve and the aortic valve]. We report a case of TV endocarditis in a 25-year-old female patient after induced abortion at 16 weeks of pregnancy presented with pyrexia of unknown origin (PUO) and septic pulmonary embolism. The patient presented with fever with chills and rigors 2 weeks after the induced abortion. She remained febrile for 1.5 months and did not respond to therapy. After subsequent investigations, she was found to have TV endocarditis. She was not an IV drug abuser and did not have any underlying cardiac anomaly or any cardiac prosthesis implantation, which are common causes of right-sided endocarditis. This patient had responded to injection ceftriaxone 1 g IV/twice a day (bd), injection vancomycin 500 mg IV/bd, and injection gentamycin 80 mg IV/bd for total 28 days and was discharged to follow-up.