INFECTIVE ENDOCARDITIS OF A PROSTHETIC PULMONARY VALVE CAUSED BY MYCOBACTERIUM ABCESSUS
Olajide Olatidoye, BS1, Dante Dali, MD2, Michael Bates, MD1.
1Brody School of Medicine at East Carolina University, Greenville, NC, USA, 2Mason City Clinic, Mason City, IA, USA.
OBJECTIVE: In this case we present a 53 y/o male who presented with a deep sternal wound infection after a redo sternotomy with 2x CABG and pulmonary valve s/p PVR with 27 mm valve with a PA patch.
METHODS: The patient presented with chest pain and underwent a redo CABG as well as a pulmonary valve replacement with a 27 mm valve with a PA patch after iatrogenic injury to the pulmonary outflow tract and pulmonary valve. The patient presented later with discharge and odor from the sternotomy indicating a deep sternal wound infection. After appropriate antibiotic administration, symptoms persisted and blood cultures were negative. Repeat blood cultures revealed Mycobacterium abcessus and a intraoperative TEE revealed infected substernal seroma.
RESULTS: Patient underwent pulmonary valve replacement and was transferred to the CVICU. The patient continued to be intermittently febrile as high as 39 C. Cultures from a pseudoaneurysm (Figure 1) and vegetation on the prosthetic valve and pulmonic patch grew acid fast bacilli. Infectious disease was consulted and initiated amikacin, imipenem and tigecycline. Wound cultures grew Mycobacterium abscessus. The patient stabilized on the antibiotic regime and was able to be sent home.
CONCLUSIONS: This patient did not have any risk factors for infective endocarditis except a prosthetic heart valve. The patient also had multiple sternal wound infections that did not stain acid fast so the question presents on whether the DSWI caused the endocarditis or was the endocarditis present and growing from the first presentation of purulent discharge of the sternal wound.
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