Diagnostics and treatment of recurrent endocarditis - case report

Infective endocarditis is an inflammation of the inner surface of the heart, which is most commonly caused by bacteria and may lead to severe complications. A 44-year-old male patient was admitted due to suspected recurrent infective endocarditis (IE). The patient had a history of infections with Staphylococcus aureus etiology in 2014, 2015, and 2018, including IE affecting the mitral valve, sepsis after a dental procedure and septic shock. On examination, the patient presented a diastolic murmur 4/6 (Levine Scale) over the apex of the heart. The enlargement of the left atrium and left ventricle was detected in the transthoracic echocardiogram. Laboratory tests revealed elevation of the C-reactive protein and the presence of Methicillin-sensitive Staphylococcus aureus in blood culture. The patient was treated with vancomycin. Single photon emission tomography and computed tomography with technetium-99m-hexamethyl propylene amino-oxime-labeled leukocytes (99mTc- HMPAO-SPECT/CT) were performed, revealing no abnormalities.Patients with the first incident of endocarditis are at risk of recurrence and of developing additional complications. Early diagnosis and treatment of infective endocarditis are vital.