PMID- 31312561
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20201001
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 11
IP  - 5
DP  - 2019 May 10
TI  - Streptococcus viridans Endocarditis Affecting All Four Valves.
PG  - e4635
LID - 10.7759/cureus.4635 [doi]
LID - e4635
AB  - Infective endocarditis (IE) affecting all four valves is rare. We describe an 
      interesting clinical scenario of a 47-year-old female, with an underlying, 
      unrepaired atrial septal defect (ASD) and hypertrophic obstructive cardiomyopathy 
      (HOCM), who presented with a five-week history of worsening lower extremity rash 
      and New York Heart Association (NYHA) class IV symptoms. She was febrile to 
      101.3 degrees F at the time of presentation. Examination revealed dental caries and track 
      mark on hands. Her extremities demonstrated palpable purpura and pitting edema. 
      Chest auscultation revealed bibasilar crackles and a grade III pan-systolic 
      murmur, best heard over the apex, with radiation to the axilla. The blood gram 
      stain resulted positive for gram-positive cocci in chains, prompting the 
      initiation of ceftriaxone. Transthoracic echocardiography (TTE) did not reveal 
      any new valvular regurgitation or vegetation. Transesophageal echocardiography 
      (TEE) showed vegetation on all four valves and underlying ASD with HOCM. Blood 
      cultures grew Streptococcus viridians. She had evidence of extensive septic 
      emboli to the brain, lungs, spleen, and intestines. Given the extent of valvular 
      involvement, intracranial hemorrhage, and tenuous hemodynamic status, a decision 
      was taken to manage her conservatively followed by elective surgical 
      management. She, however, went into cardiogenic shock further complicated by 
      lower gastrointestinal bleed and passed away.
FAU - Kumar, Manish
AU  - Kumar M
AD  - Internal Medicine, University of Connecticut Health Center, Farmington, USA.
FAU - Anstadt, Emily J
AU  - Anstadt EJ
AD  - Internal Medicine, University of Connecticut Health Center, Farmington, USA.
FAU - Lopetegui Lia, Nerea
AU  - Lopetegui Lia N
AD  - Internal Medicine, University of Connecticut Health Center, Farmington, USA.
FAU - Siddiqi, Misbahul H
AU  - Siddiqi MH
AD  - Internal Medicine, Hartford Hospital, Hartford, USA.
LA  - eng
PT  - Case Reports
DEP - 20190510
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC6623990
OTO - NOTNLM
OT  - atrial septal defect (asd)
OT  - dental caries
OT  - hypertrophic obstructive cardiomyopathy
OT  - native valve endocarditis
OT  - viridans
COIS- The authors have declared that no competing interests exist.
EDAT- 2019/07/18 06:00
MHDA- 2019/07/18 06:01
PMCR- 2019/05/10
CRDT- 2019/07/18 06:00
PHST- 2019/07/18 06:00 [entrez]
PHST- 2019/07/18 06:00 [pubmed]
PHST- 2019/07/18 06:01 [medline]
PHST- 2019/05/10 00:00 [pmc-release]
AID - 10.7759/cureus.4635 [doi]
PST - epublish
SO  - Cureus. 2019 May 10;11(5):e4635. doi: 10.7759/cureus.4635.