A Rare Case of Isolated Papillary Muscle Endocarditis.

Abstract

A septuagenarian woman, who had recently undergone ureteral stenting, presented with 3 days of malaise and altered mental status. Physical examination revealed a febrile patient with normal blood pressure, heart and respiratory rate. Skin inspection exhibited maculopapular lesions on the extremities and splinter hemorrhages. Laboratory results were remarkable for a white-cell count of 15,400 /mm 3 and a C-reactive protein level of 237 mg/L. Abdominal computed tomographic scan exposed multiple spleen infarcts and brain magnetic resonance imaging showed multiple small diffusion defects ( Figure 1 ). A transesophageal echocardiogram (TOE) was performed and revealed a large vegetation (29 × 14 mm), protruding into the left ventricular outflow tract, attached to the posteromedial papillary muscle without affecting mitral valve function ( Figures 2 and 3 , Movies 1 and 2 ). Blood and urine cultures isolated methicillin-resistant Staphylococcus aureus (MRSA). Endocarditis associated with urosepsis was diagnosed, appropriate antibiotherapy was initiated and the patient underwent urgent cardiac surgery with preservation of the mitral valve. Histological and microbiological analysis of the resected material from the subvalvular apparatus confirmed endocarditis by MRSA. Staphylococcus aureus is highly virulent, linked to hospital care, and frequently related to non-valvular endocarditis. 1)