Infective endocarditis with embolic syndrome. Clinical case

Abstract

Introduction. Infective endocarditis (IE) presents with systemic embolic complications in 10-57% of cases: cerebral (26.3%), splenic (6.8%), and pulmonary (6.1-32%), leading to a malignant course with disabilities (172,359 cases/year). Early diagnosis and targeted treatment facilitate a favorable prognosis. Objective(s). Description of the clinical case of a patient with infectious endocarditis and emboli in three organs. Importance of early diagnosis and personalized treatment in the management of IE. Materials and methods. Female, 63 years old, with streptococcal infective endocarditis, involving the aortic valve (AV), with systemic and pulmonary emboli, admitted to the cardiology department of the CMH "Holy Trinity". Onset with fever, sweating, severe abdominal pain. Clinically and paraclinically investigated through echocardiography, blood cultures, biomarkers. Results. Fever of 40.6°C, chills, dyspnea, palpitations. Physical examination: pale skin, Osler nodes. Heart rate 120 bpm, diastolic murmur at the aortic area, blood pressure 130/90 mmHg. Investigations: blood cultures (3 sets) Streptococcus β-haemolyticus. ECHO: 20 mm vegetations on the aortic valve, grade II aortic regurgitation, ejection fraction 55%. ESR 50 mm/h; rheumatoid factor negative; CRP 96 U/L; D-dimers 500 ng/mL. Abdominal ultrasound: splenic and renal emboli. Chest X-ray: small-branch pulmonary embolism (PE). Treatment included antimicrobial, antifungal, anticoagulant agents, and β-blockers, with an unfavorable prognosis. Conclusion(s). Infective endocarditis, when diagnosed late, is complicated by severe valvular regurgitation and large vegetations, the fragmentation of which leads to multiple embolic syndrome, worsening the disease progression, hindering timely treatment, and often progressing toward an unfavorable outcome.