Aortic Insufficiency Secondary to Enterococcus faecalis Endocarditis in an HIV-Positive Patient

Abstract

Enterococcus faecalis is the third most common cause of endocarditis. HIV infection is an independent risk factor for the development of endocarditis when the cell count is below 200 cells/mL and without retroviral therapy. A 49-year-old Caucasian male, with HIV infection in triple therapy, no detectable viral counts and CD4 cell count over 1,000 cells/mL, is admitted to the hospital with dyspnea and an acute bacterial infection. On the physical exam, he presented tachycardia, systolic murmur I/IV, bilateral basilar rales, hypotension and fever. The echocardiogram showed an aortic valve vegetation, with prolapse of one of the leaflets, severe aortic insufficiency, mild mitral regurgitation and severe pulmonary hypertension. CXR with bilateral infiltrations and CT scan showed in addition mediastinal lymphadenopathy. He underwent an emergency cardiac surgery replacing his aortic valve for a prosthetic, and the culture of the vegetation was positive for E. faecalis. Treatment with vancomicin and gentamicin was initiated. Infective endocarditis by E. faecalis in this patient had probably a non-HIV-related etiology because of the adequate antiretroviral therapy that he was having. Most probably the rectal abscess could have been the source of the sepsis.




J Med Cases. 2015;6(2):51-54
doi: http://dx.doi.org/10.14740/jmc1946w