Case Study

A young man presented to hospital with acutely painful legs. He had chronic osteomyelitis and took chronic oral antibiotics. Leg ischemia was diagnosed and surgical thrombectomy yielded large pale thrombi from both leg arteries. Due to the suspicion of a potential cardiac source, an echocardiogram was performed, which demonstrated aortic and mitral vegetations with valve destruction and an aorto-right atrial fistula. Surgical replacement of the aortic and mitral valves was performed and the intracardiac fistula was closed. The excised leg thrombi and the valve vegetations all grew Aspergillus (Figure 2.10). Antifungal medications were administered. Postoperatively the individual continued to be septic with recurrent strokes and died a few weeks after surgery.

At autopsy the fistula between the aorta and right atrium was still infected (Figure 2.14). The tricuspid valve had new fungal vegetations. The strokes were due to embolic cerebral infarctions, as the intracardiac fungal vegetation had massively re-occurred at the aortic valve prosthesis site partially immobilized the valve discs and parts of the vegetation had embolized to the brain (Figure 2.18).

Infective endocarditis (IE) has many clinical manifestations, not just limited to the heart. Pathology is important in the diagnosis of endocarditis and assessment of valvular and perivalvular complications.

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