BARLOW’S DISEASE IN NATIVE VALVE ENDOCARDITIS WITH STAPHYLOCOCCUS EPIDERMIDIS - A CASE REPORT

Infective endocarditis (IE) is associated with high mortality if left untreated and is associated with many complications such as: septic emboli, abscesses, valvular rupture or congestive heart failure. We present below the case of a 69-year-old male who presented to the emergency room for exertional dyspnea, malaise and fatigue, symptoms that started for several months with progressive worsening. The cardiac examination highlighted a systolic murmur in the mitral area in concordance with the echocardiographic findings that revealed severe mitral regurgitation along with a degenerative-myxomatous appearance of the mitral valve, suggestive for Barlow’s disease, as well as a hyperechogenic mass on the mitral valve. Empirical therapy was initiated intravenously with vancomycin and gentamicin after three blood cultures were harvested. The blood cultures were positive for Staphylococcus (S.) epidermidis and given the antibiogram’s susceptibility to vancomycin and daptomycin, the treatment was subsequently continued only with vancomycin. Albeit coagulase negative staphylococci such as S. epidermidis are usually found at patients with risk factors: valvular prostheses, implantable devices, hemodialysis or intravascular catheters, in our case the patient had no such risk factors, but instead developed IE on a native, degenerated valve. The patient was referred to the cardiovascular surgeon and subsequently, a prosthetic, bidisc mitral valve was implanted along with tricuspid annuloplasty. The recovery was uneventful and at 6 months of follow-up the patient was asymptomatic with no complications.