Irina Iuliana Costache

Streptococcus gallolyticus-induced “kissing abscess” of anterior mitral valve leaflet and intervalvular fibrosa from an aortic valve endocarditis – a case of delayed diagnosis

A fatal disease until Mid-Twentieth Century, nowadays infective endocarditis is curable due to advances in diagnostic techniques, especially in echocardiography, the possibility of cardiac surgery during the active infectious process and new antibiotics. We present a 62 years-old man, with no significant past medical illness, referred for persistent cough, fatigue, shortness of breath, loss of weight and paleness, with recent history of persistent fever and positive blood cultures with Streptococcus gallolyticus. Echocardiographic examination revealed aortic and mitral valve vegetations and anterior mitral valve leaflet abscess. During surgery, the presence of a “kissing abscess” on the atrial side of the anterior mitral leaflet, arising from a vegetation on the non-coronary cusp of the aortic valve, was confirmed, together with an intervalvular fibrosa abscess. Special reinforcement with an oversewn bovine pericardial patch and reconstruction of the intervalvular fibrous body was necessary during aortic and mitral valve replacement. Despite delayed diagnosis, the case had a favorable outcome, the patient being discharged presenting a good clinical state. Numerous complications, including abscesses and early infective endocarditis on prosthetic aortic valve, would have been probably avoided with prompt recognition and early treatment of endocarditis.