Trauma: An Unusual Cause of Endocarditis.

INTRODUCTION:Infective endocarditis (IE) remains a dangerous condition with considerable associated mortality. Usual risk factors for IE include the presence of a prosthetic heart valve, structural or congenital heart disease, intravenous drug use, and a recent history of invasive procedures. METHODS:The authors describe the case report of a patient with IE having trauma as an unusual risk factor. RESULTS:A 33-year old male patient was referred to our department due to infective endocarditis. The patient had a fever of unknown origin for 15 days before going to the emergency department. After admission it was identified by transthoracic echocardiography a 14mm posterior abscess of the aortic valve provoking major aortic regurgitation with moderate LV dysfunction. After careful evaluation of the clinical history it was found that the patient had a known bicuspid aortic valve with follow-up since the age of 14. All other usual risk factors for IE were excluded, including intravenous drug use and recent history of invasive procedures. The only relevant previous event was a traumatic haemathoma in his left jaw caused by a working accident with an iron beam in a construction site as the patient is a civil engineer. Vancomycin plus gentamicin were empirically started after blood cultures taken. The isolated infective agent was Staphylococcus lugdunensis methicillin sensitive and the antibiotherapy was de-escalated to flucloxacilin plus gentamicin. Due to cardiac dysfunction the patient was submitted to cardiac surgery on the fourth day of directed antibiotic therapy and a replacement of the aortic valve by a mechanical prosthetic valve and closure of the abscess with bovine pericardial patch was performed. The valve sent to microbiology evaluation showed the same infective provocative agent. The patient had a good clinical and laboratorial recovery completing the 42-day antibiotic scheme. After antibiotherapy period completion, echocardiography was repeated and the abscess found was larger then the previous one, presenting itself like an aortic pseudo aneurysm. The patient was resubmitted to surgery with re-closure of the initial abscess with autologous pericardial patch and replacement of the prosthetic mechanical valve for an undersized one. The patient was discharger clinically well, having a complete normal life at the moment. CONCLUSION:This clinical case illustrates trauma as an unusual cause of endocarditis and emphasizes the importance of a detailed clinical history.