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Correspondence: Address to Shigeo Godo, MD, PhD, Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.
Affiliations
Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, JapanDepartment of Emergency and Critical Care Medicine, Tohoku University Hospital, Sendai, Japan
Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, JapanDepartment of Emergency and Critical Care Medicine, Tohoku University Hospital, Sendai, Japan
A 74-year-old man with a history of prosthetic aortic valve replacement 4 years before presentation was evaluated for a fever since the previous day. Although multiple blood cultures were positive for penicillin-susceptible Streptococcus gordonii, an oral viridans streptococcus vegetation was not detected by echocardiography, and the modified Duke criteria for infective endocarditis were not met. Despite treatment with penicillin G (18 million units daily) for 2 weeks after negative blood cultures, 4 days after the last dose blood cultures turned positive for the identical organism. Results of repeated echocardiography and physical examinations were unremarkable. Laboratory results showed a mild increase in erythrocyte sedimentation rate and a positive rheumatoid factor, which were suggestive of, but still inconclusive for, the diagnosis of infective endocarditis. 18F-fluorodeoxyglucose positron emission tomography/computed tomography demonstrated a focal hot spot of fluorodeoxyglucose uptake around the prosthetic valve (Figure), a new major criterion for the diagnosis of prosthetic valve endocarditis in the latest guidelines.
2015 ESC guidelines for the management of infective endocarditis: the Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC) Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM).
We diagnosed prosthetic valve endocarditis, which was cured using a higher dose of penicillin G (24 million units daily) for 6 weeks following negative blood cultures without any complications.
FigureAbnormal fluorodeoxyglucose uptake around the site of aortic prosthetic valve (arrow).
Transthoracic echocardiography is still useful in the initial evaluation of patients with suspected infective endocarditis: evaluation of a large cohort at a tertiary referral center.
18F-fluorodeoxyglucose positron emission tomography/computed tomography is useful for the diagnosis of infective endocarditis in patients with prosthetic valves, especially when the conventional modified Duke criteria are not met despite a high clinical suspicion of the disease.
2015 ESC guidelines for the management of infective endocarditis: the Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC) Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM).
Transthoracic echocardiography is still useful in the initial evaluation of patients with suspected infective endocarditis: evaluation of a large cohort at a tertiary referral center.
Potential Competing Interests: Dr Kushimoto is a board member for CSL Behring; is a consultant to Alexion; receives departmental grants from Pfizer , Asahikasei , Teijin , Nihon Pharmaceutical , Shionogi Pharmaceutical , and Dainihonsumitomo Pharmacuetical ; and serves on the speakers bureaus for Pfizer, Asahikasei, Teijin, Nihon Pharmaceutical, Shionogi Pharmaceutical, Ono Pharmaceutical, and CSL Behring. The other author reports no competing interests.
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