Infective endocarditis complicated by septic nephritis. Clinical case

Abstract

Introduction. Infective endocarditis (IE) is a severe microbial disease that often occurs on the Background. of comorbidities and progresses with multi-organ complications, negatively impacting the disease prognosis. The condition leads to renal dysfunction and may be complicated by embolism and septic nephritis. Aim of the study. Presentation of a clinical case of streptococcal infective endocarditis complicated by septic nephritis, highlighting the role of early diagnosis and multidisciplinary management. Materials and methods. A 63-year-old male with prosthetic valve IE caused by group D streptococcus affecting the aortic valve (AoV). Medical history revealed onset with fever, chills, sweating, dyspnea, parasternal pain. He was clinically and paraclinically investigated through blood cultures, ECHO, clinical and biochemical analyses, nephrologist consultation. Results. Fever 37.7°C, dyspnea, lumbar pain. Objective(s). findings: skin pallor, rhythmic heart sounds, HR 100 bpm, diastolic murmur over the aorta, BP 140/100 mmHg. Paraclinical findings: blood cultures positive for group D streptococcus. ECHO showed mobile vegetations on the AV (20 mm), grade II aortic regurgitation, EF 57%. Laboratory: Hb 90 g/l, erythrocytes 2.7 x 10¹²/L, leukocytes 14 x 10⁹/L, ESR 68 mm/h, urea 10 mmol/L, creatinine 146 μmol/L, RF negative, CRP 61 U/L. Urinalysis revealed leukocyturia, hematuria, and hyaline casts. The patient received three antimicrobial drugs at maximum doses, antifungals, low molecular weight anticoagulants. Conclusion(s). Streptococcal infective endocarditis (caused by Streptococcus gallolyticus, viridans, β-hemolytic streptococci) may progress with septic nephritis, worsening the disease prognosis, particularly in elderly patients. Adequate infection treatment is crucial to minimizing the risk of renal impairment.