Primary infective endocarditis with isolated involvement of the pulmonary valve not associated with drug addiction

Objective: to describe a rare case of infective endocarditis (IE) with isolated localization in the pulmonary valve (PV).

Materials and methods. We observed primary IE with isolated localization in the PV in a 27-year-old female patient without risk factors of right-side IE.

Results. The disease was caused by Streptococcus gordonii and proceeded acutely with typical signs of right-side IE: fever above 38 °С, chills, clinical picture of bilateral septic embolic abscess pneumonia, as well as secondary anemia, secondary thrombocytopenia, and glomerulonephritis. Echocardiography showed large vegetations in the PV prolapsing in the right ventricle and pulmonary artery.

Conclusion. IE with localization in the PV should be suspected in patients with fever and clinical picture of septic embolic pneumonia in absence of other embolic situations.

1. Park L. P., Chu V. H., Peterson G. et al. Validated Risk Score for Predicting 6-Month Mortality in Infective Endocarditis J Am Heart Assoc 2016;5(4):e003016. DOI: 10.1161/JAHA.115.003016.

2. Tyurin V. P. Infective endocarditis. Ed. Academician of the Russian Academy of Medical Sciences Yu. L. Shevchenko. Moscow: GEOTAR-Media, 2012. (In Russ.)

3. Cresti A., Baratta P., De Sensi F. et al. Frequency and Clinical Significance of Right Atrial Embryonic Remnants Involvement in Infective Endocarditis. J Heart Valve Dis 2017;26(6):700–7.

4. Chipigina N. S., Shostak N. A., Vinogradova T. L. Malysheva A. M. Infective endocarditis in intravenous drug users. Vestnik RGMU = Bulletin of RSMU 2009;(7):97–101. (In Russ.)

5. Lee M. R., Сhang S. A., Choi S. H. et al. Clinical Features of Right-Sided Infective Endocarditis Occurring in Non-Drug Users. J Korean Med Sci 2014;29(6):776–81. DOI: 10.3346/jkms.2014.29.6.776.

6. Mathura K. C., Thapa N., Rauniyar A. et al. Injection drug use and tricuspid valve endocarditis. Kathmandu Univ Med J(KUMJ) 2005;3(1):84–6.

7. Moss R., Munt B. Injection drug use and right sided endocarditis. Heart 2003; 89(5):577–81.

8. Buber J., Bergersen L., Lock J. E. et al. Bloodstream infections occurring in patients with percutaneously implanted bioprosthetic pulmonary valve: a singlecenter experience. Circ Cardiovasc Interv 2013;6(3):301–10. DOI: 10.1161/CIRCINTERVENTIONS.112.000348.

9. Asgeirsson H., Thalme A., Weiland O. Low mortality but increasing incidence of Staphylococcus aureus endocarditis in people who inject drugs Experience from a Swedish referral hospital Medicine(Baltimore). 2016;95(49):e5617. DOI: 10.1097/MD.0000000000005617.

10. Frontera J. A., Gradon J. D. Right-side endocarditis in injection drug users: review of proposed mechanisms of pathogenesis. Clin Infect Dis 2000;30(2):374–9. DOI: 10.1086/313664.

11. Revilla A., Lopez J., Villacorta E. et al. Isolated right-sided valvular endocarditis in non-intravenous drug users. Rev Esp Cardiol 2008;61(12):1253–9.

12. Alves M., Faria R., Messias A., Meneses-Oliveira C. Eustachian Valve Endocarditis: Echocardiographic Diagnosis ina Critical Care Patient. Case Rep Crit Care 2018;2018:5193976. DOI: 10.1155/2018/5193976.

13. English N., Weston P. Multivalvular infective endocarditis in pregnancy presenting with septic pulmonary emboli BMJ Case Rep 2015; PII: bcr2014209131. DOI: 10.1136/bcr-2014-209131.

14. Chowdhury M. A., Moukarbel G. V. Isolated pulmonary valve endocarditis. Cardiology 2016;133(2):79–82. DOI: 10.1159/000440857.

15. Nakamura K., Satomi G., Sakai T. et al. Clinical and echocardiographic features of pulmonary valve endocarditis. Circulation 1983;67(1):198–204.

16. Vaideeswar P., Jawale R. M., Tullu M. Isolated infective endocarditis of the pulmonary valve: an autopsy analysis of nine cases. Cardiovasc Pathol 2009;18(4):231–5. DOI: 10.1016/j.carpath.2008.06.011.

17. Miranda W. R., Connolly H. M., DeSimone D.C. et al. Infective Endocarditis Involving the Pulmonary Valve. Am J Cardiol 2015;116(12):1928–31. DOI: 10.1016/j.amjcard.2015.09.038.

18. Hamza N., Ortiz J., Bonomo R. A. Isolated pulmonic valve infective endocarditis: a persistent challenge. Infection 2004;32(3):170–5.

19. Akram M., Khan I. A. Isolated pulmonic valve endocarditis caused by group B streprococcus(Streptococcus agalactiae) – a case report and literature review. Angiology 2001;52(3):211–5. DOI:10.1177/000331970105200309.

20. Samaroo-Campbell J., Hashmi A., Thawani R. et al. Isolated Pulmonic Valve Endocarditis. Am J Case Rep 2019;20: 151–3. DOI: 10.12659/AJCR.913041.

21. Laursen M. L., Gill S., Moller J. E., Guastavsen. Healthcare-associated infective endocarditis of the pulmonary valve. BMJ Case Rep 2015;2015. PII: bcr2014207577. DOI: 10.1136/bcr-2014-207577.

22. Schroeder R. A. Pulmonic valve endocarditis in a normal heart. J Am Soc Echocardiogr 2005;18(2):197–8. DOI: 10.1016/j.echo.2004.08.006.

23. Gersony W. M., Hayes C. J., Driscoll D. J. et al. Bacterial endocarditis in patients with aortic stenosis, pulmonary stenosis, or ventricular septal defect. Circulation 1993;87(2 Suppl): 121–6.

24. Hatemi A. C., Gursoy M., Tongut A. et al. Pulmonary stenosis as a predisposing factor for infective endocarditis in a patient with Noonan syndrome. Tex Heart Inst J 2010;37(1):99–101.

25. Inchaustegui C. A., Wang K. Y., Teniola O., De Rosen V. L. Large septic pulmonary embolus complicating streptococcus mutans pulmonaryvalve endocarditis. J Radiol Case Rep 2018;12(2):18–27. DOI: 10.3941/jrcr.v12i2.3240.

26. Goswami U., Brenes J. A., Punjabi G. V. et al. Associations and outcomes of septic pulmonary embolism. Open Respir Med J 2014;8:28–33. DOI: 10.2174/1874306401408010028.

27. Vrettos A., Mota P., Nash J. et al Pneumococcal pulmonary valve endocarditis. Echo Res Pract 2017. PII: ERP-17–0026. DOI: 10.1530/ERP-17–0026.

28. Swaminath D., Yaqub Y., Narayanan R. et al. Isolated Pulmonary Valve Endocarditis Complicated With Septic Emboli to the Lung Causing Pneumothorax, Pneumonia, and Sepsis in an Intravenous Drug Abuser. J Investig Med High Impact Case Rep 2013;1(4). DOI: 10.1177/2324709613514566.

29. Goud A., Abdelqader A., Dahagam C., Padmanabhan S. Isolated pulmonic valve endocarditis presenting as neck pain. J Community Hosp Intern Med Perspect 2015;5(6):29647. DOI: 10.3402/jchimp.v5.29647.eCollection 2015.

30. Passen E., Feng Z. Cardiopulmonary manifestations of isolated pulmonary valve infective endocarditis demonstrated with cardiac CT. J Cardiovasc Comput Tomogr 2015;9(5):399–405. DOI: 10.1016/j.jcct.2015.03.013.

31. Edmond J. J., Eykyn S. J., Smith L. D. Community acquired staphylococcal pulmonary valve endocarditis in non-drug users: Case report and review of the literature. Heart 2001;86(6):E17.

32. Li D., Zhu Z, Zheng X. et al. Gemella morbillorum endocarditis of pulmonary valve: a case report. J Cardiothorac Surg 2017;12(1):16. DOI: 10.1186/s13019-017-0579-3.

33. Habib G., Lancellotti P., Antunes M. J. et al. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 2015;36(44):3075–128. DOI:10.1093/eurheartj/ehv319.

34. Joskowiak D., Kappert U., Matschke K., Tugtekin S. M. Ruptured pulmonary artery caused by isolated pulmonary valve endocarditis: case report. Clin Res Cardiol 2010;99(7):471–3.