Streptococcus agalactiae infective endocarditis with large vegetation in a patient with underlying protein S deficiency
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CASE REPORT
Streptococcus agalactiae infective endocarditis with large vegetation in a patient with underlying protein S deficiency H.-L. Cheng • W.-C. Lin • P.-Y. Shih • C.-H. Huang • Y.-C. Hsu • J.-C. Yie • S.-Y. Chen • C.-P. Lin
Received: 3 May 2012 / Accepted: 8 September 2012 / Published online: 22 September 2012 Ó Springer-Verlag 2012
Abstract We present a case of a patient with underlying protein S deficiency who suffered from infective endocarditis with a large anterior mitral leaflet (AML) mass of approximately 4.5 cm in length. Intraoperative transesophageal echocardiography (TEE) revealed the mass at the AML base and a rupture of the posterior mitral leaflet chordae tendinae. The vegetation’s large size may have been caused by one or more of three factors: location, underlying disease, and the microorganism causing infection. Patients with protein S deficiency are prone to thromboembolic events during cardiac surgery. Infective endocarditis caused by Streptococcus agalactiae usually has a poor prognosis, and, thus, early surgery is recommended.
Introduction Streptococcus agalactiae, also known as group B streptococcus (GBS), is an uncommon (1.7–3 %) but aggressive infective endocarditis (IE) pathogen. It usually causes large ([1 cm) vegetations, valve damage, heart failure, and thromboembolism [1, 2]. Protein S, a co-enzyme of protein C, can inhibit factor V and VIII during coagulation. Patients with protein S deficiency, which is an autosomal dominant disease, are prone to thromboembolic events during cardiac surgery [3].
Case presentation Keywords Streptococcus agalactiae Infective endocarditis Protein S deficiency Vegetation Mitral valve Transesophageal echocardiography Electronic supplementary material The online version of this article (doi:10.1007/s15010-012-0334-6) contains supplementary material, which is available to authorized users.
An 81-year-old woman with underlying hypertension, diabetes mellitus, and protein S deficiency was referred for a workup due to fever and drowsiness. She was previously followed up at our out-patient department for protein S deficiency. There were no reports of a thromboembolic event in recent years. Under room air, tachypnea was noted
H.-L. Cheng P.-Y. Shih C.-H. Huang J.-C. Yie Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan, Republic of China e-mail: [email protected]
Y.-C. Hsu Department of Anesthesiology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan, Republic of China e-mail: [email protected]
P.-Y. Shih e-mail: [email protected] C.-H. Huang e-mail: [email protected] J.-C. Yie e-mail: [email protected] W.-C. Lin Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan, Republic of China e-mail: [email protected]
S.-Y. Chen Department of Anesthesiology, Penghu Hospital, Penghu, Taiwan, Republic of China e-mail: [email protected] C.-P. Lin (&) Departments of Anesthesiology and Oncology, National Taiwan University Hospital, No. 7, Chung-Shan S
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