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Giant progressive mitral vegetation in a case of infective endocarditis caused by Streptococcus agalactiae

  • Case image in cardiovascular ultrasound
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Fig. 1

Data Availability

The data that support the findings of this case report are available from the corresponding author upon reasonable request.

References

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Acknowledgements

We thank Dr. Kazumasa Tsuda (First Department of Surgery, HUSM) for performing the surgical procedure and Mina Honda (Department of Diagnostic Pathology, HUSM) for performing the pathological sample processing.

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Authors and Affiliations

  1. Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan

    Gyo Susukida, Atsushi Sakamoto, Keisuke Iguchi, Hayato Ohtani & Yuichiro Maekawa

  2. Department of Diagnostic Pathology, Hamamatsu University School of Medicine, Hamamatsu, Japan

    Mayu Fujihiro

  3. First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan

    Norihiko Shiiya

Authors
  1. Gyo Susukida
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  2. Atsushi Sakamoto
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  3. Keisuke Iguchi
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  4. Mayu Fujihiro
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  5. Hayato Ohtani
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  6. Norihiko Shiiya
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  7. Yuichiro Maekawa
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Corresponding author

Correspondence to Atsushi Sakamoto.

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The authors confirm that written consent for submission and publication of this case report has been obtained from the patient in line with COPE guidance.

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Supplementary Information

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12574_2023_633_MOESM1_ESM.pdf

Supplemental figure 1. Magnetic resonance images (MRI), magnetic resonance angiography (MRA), and contrast-enhanced computed tomography (CT) images Diffusion weighted MRI (A-B) and MRA image (C) of brain. Abdominal contrast-enhanced CT image (D). Yellow arrowheads indicate embolic infarct areas (PDF 431 KB)

12574_2023_633_MOESM2_ESM.pdf

Supplemental figure 2. Clinical course and antibiotics treatment. The initial potential diagnosis of this case on admission was bacterial pneumonia. Then an empiric antibacterial treatment with Meropenem (1.5 g/day) and Levofloxacin (initial 500 mg/day followed by 250 mg/day) were started. On day-2, TTE examination revealed floating mass on the surface of mitral valve and blood culture detected gram positive cocci. Levofloxacin was changed to Teicoplanin (initial 600 mg/day followed by 350 mg/day) for covering MRSA. On day-4, Streptococcus agalactiae and its antibacterial spectrum was confirmed. After the surgical removal of the vegetation and the mitral valve replacement with a bioprosthetic valve on day-5, the regimen of antibiotics was changed to Penicillin G (24 million units/day) and Gentamicin (150 mg/day). Due to drug-induced skin eruption, these drugs have been replaced to Vancomycin (2 g/day) on 5 post-operative day. Because of drug-induced kidney damage, Vancomycin has been changed to Ceftriaxone (4 g/day) on 11 post-operative day and continued thereafter until 42 post-operative day. Ab, antibiotics; CTRX, ceftriaxone; GM, gentamicin; GPC, gram-positive cocci; LVFX, levofloxacin; MEPM, meropenem; PCG, penicillin G; TEIC, teicoplanin; VCM, vancomycin (PDF 14 KB)

Supplemental video 1. Transthoracic echocardiographic findings (parasternal view [A] and with color Doppler [B]. 4 chamber view [C] and with color Doppler [D]) on day-2 (MP4 14753 KB)

Supplemental video 2. Transthoracic echocardiographic findings (parasternal view [A] and with color Doppler [B]. 4 chamber view [C] and with color Doppler [D]) on day-4 (MP4 16581 KB)

Supplemental video 3. Intraoperative transesophageal echocardiographic finding (2 chamber view) (MP4 1809 KB)

Supplemental video 4. Intraoperative transesophageal echocardiographic finding (2 chamber view with color Doppler) (MP4 3028 KB)

Supplemental video 5. Intraoperative transesophageal echocardiographic finding (3-dimensional Doppler transverse image of mitral valve) (MP4 2961 KB)

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Susukida, G., Sakamoto, A., Iguchi, K. et al. Giant progressive mitral vegetation in a case of infective endocarditis caused by Streptococcus agalactiae. J Echocardiogr (2024). https://doi.org/10.1007/s12574-023-00633-9

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  • DOI: https://doi.org/10.1007/s12574-023-00633-9

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