A 79-year-old woman presented to another hospital with complaints of right leg pain. Computed tomography and magnetic resonance imaging of the spine was performed in the other hospital, which showed an abscess in the right iliacus muscle. She was referred to our hospital because of a mass in the right atrium on echocardiography. Inflammatory markers were elevated, and Staphylococcus aureus were identified in blood cultures. Transthoracic echocardiography revealed a shaggy mass in the right atrium that resembled vegetation. Transesophageal echocardiography showed a large cystic mass with a hyperechoic lesion. After surgery, biopsy results indicated that it was a myxoid mass with cystic changes.

We report a rare case of tricuspid valve and pulmonary valve endocarditis associated with a double-chambered right ventricle in an adult female with pulmonary artery aneurysm and septic pulmonary embolism by Streptococcus mitis. She was treated with aggressive antibiotic therapy followed by debridement of the infective lesion of tricuspid valve, pulmonary valve replacement using xenograft and resection of obstructing muscular bundles in right ventricle.

It is necessary to distinguish between pyogenic and tuberculous spondylitis of infectious spondylitis, if it is pyogenic spondylitis, antimicrobial therapy should be directed against an identified microorganism and clinical assessment should be done at 4 weeks. But if microorganism is a anaerobic bacteria, especially Peptostreptococcus anaerobius, combination antibiotic therapy should be considered bacause it may be a component of mixed infections as a passenger and have abilities to induce abscesses, other bacterial growth as a synergy effect. In addition, echocardiography may be necessary because pyogenic spondylitis is associated with infective endocarditis about 12%. We report a 64-year-old man who was treated for infectious spondylitis accompanied by Peptostreptococcus anaerobius bacteremia, but had to undergo heart surgery because an attack of infective endocarditis with systemic embolism during hospitalization.

Citations

Citations to this article as recorded by  

• Endocarditis due to Gram Positive Anaerobic Cocci: First report of Peptoniphilus indolicus endocarditis and literature review
  Julie Lourtet-Hascoet, Sébastien Hascoet, Jean-Louis Galinier, Benoît Fontenel, Benoît Monteil, Eric Bonnet
  Clinical Infection in Practice.2021; 11: 100073.     CrossRef