SHM Converge Scientific Abstract ePoster Gallery-A Heart-Breaking Case of Aortic Root Abscess Rupture

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This case describes a 61-year-old man with HIV on effective HAART and a known bicuspid aortic valve (BAV) who presented with fever, abdominal pain, and diarrhea. He was initially found to have sepsis, leukocytosis, elevated troponin, and mildly elevated lipase, but no clear cardiac symptoms. Early testing suggested possible pancreatitis or gastroenteritis, and his troponin rise was initially attributed to type II NSTEMI in the setting of sepsis. Blood cultures were obtained, and initial transthoracic echocardiogram showed a mildly dilated aortic root, which was thought to be chronic.<br /><br />By hospital day 3, blood cultures grew Haemophilus parainfluenzae, a HACEK organism known to cause indolent infective endocarditis and often delay diagnosis because of slow culture growth. In the setting of BAV, which significantly increases the risk of infective endocarditis, this infection progressed rapidly. On day 4, the patient developed acute chest pain and shortness of breath, with new ECG changes including first-degree AV block and ST depressions, along with a major troponin rise. Repeat echocardiography revealed an aortic root abscess that had likely ruptured into the LVOT, causing new severe aortic regurgitation. Cardiology and cardiothoracic surgery were urgently consulted, but before surgery could be performed, the patient deteriorated into cardiopulmonary arrest and died.<br /><br />The discussion emphasizes that BAV is a major but often underrecognized risk factor for infective endocarditis, accounting for a disproportionate number of cases. Aortic root dilation can complicate interpretation of echocardiograms in these patients. The key clinical lesson is that patients with BAV who present with sepsis should be evaluated early for infective endocarditis, even without cardiac symptoms, because prompt diagnosis is critical for surgical intervention and survival.

Asset Subtitle

Xinyuan Wu

Meta Tag

Author List Cindy Fang, Reid Woods, Xinyuan Wu

Category Clinical Vignettes

Concept Bicuspid Aortic Valve

Concept Infective Endocarditis

Concept HACEK Organisms

Concept Haemophilus parainfluenzae

Concept Aortic Root Abscess

Distinguished Non-Finalist

Presenter Organization NYU Langone Health

Presenting Author Xinyuan Wu

Track Adult

Keywords

bicuspid aortic valve

infective endocarditis

Haemophilus parainfluenzae

HACEK organism

aortic root abscess

sepsis

HIV

troponin elevation

aortic regurgitation

cardiopulmonary arrest

Bicuspid Aortic Valve

Infective Endocarditis

HACEK Organisms

Haemophilus parainfluenzae

Aortic Root Abscess