NOT THE EXPECTED DIPLOCOCCI: A RARE CASE OF GONOCOCCAL INFECTIVE ENDOCARDITIS J Dubuc, D Montgomery, S Vignes Department of Internal Medicine, LSU Health Sciences Center, New Orleans, Louisiana
INTRODUCTION Neisseria gonorrhoeae is a gram-negative diplococci bacteria responsible for over 80 million cases of urethritis in men and women every year. Infections rarely spread to distant sites such as skin, brain, joints, and even heart valves. Gonococcal endocarditis has been described in the literature fewer than 150 times, yet it portends a 19% mortality with 50% of cases requiring surgical intervention. CASE: A 56-year-old Caucasian man with a history of nephrolithiasis, coronary artery disease, and hypertension presented to the emergency department for 5 months duration of chest pain, fever, and chills. The chest pain was described as sternal intermittent aching pain with associated fevers, night sweats and rigors. The patient denied penile lesions, dysuria, and urethral discharge. Other pertinent history includes recent multiple laser lithotripsy procedures to treat nephrolithiasis. Temperature upon arrival to the emergency department was 100.1 o F, physical exam was remarkable for a grade II/VI holosystolic murmur at the left mid-sternal border. Labs remarkable for WBC 8.4 10^3/uL ESR 77 mm/hr, CRP 9.7 mg/dL , and BNP 166 pg/mL On trans-thoracic echocardiogram a highly mobile 3.3x1.7cm vegetation on the septal leaflet of the tricuspid valve was visualized resulting in severe tricuspid regurgitation. On hospital day #2, blood cultures resulted positive for Neisseria gonorrhoeae . Empiric antibiotics were changed to Ceftriaxone 2g every 12 hours. On hospital day #8, the patient underwent tricuspid valve replacement with a mechanical valve. He was discharged on hospital day #14 with plans to complete a 6-week course of ceftriaxone. His course was later complicated by a pericardial effusion and supratherapeutic INR requiring emergent pericardiocentesis. DISCUSSION: Gonococcal Endocarditis will inherently become increasingly common due to rising cases of gonorrhea STIs and antibiotic resistance. Identification of genitourinary infections and early effective treatment is imperative to prevent serious sequelae. In this case, genitourinary manipulation for treatment of nephrolithiasis in the setting of active gonococcal infection was likely the nidus of hematogenous spread.
5
Made with FlippingBook Digital Publishing Software