SHM Converge Scientific Abstract ePoster Gallery-An Unusual Presentation of an Already Rare Diagnosis: Salmonella Endocarditis

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This case report describes a very rare presentation of infective endocarditis caused by Salmonella species in a non-native aortic valve. An 80-year-old Caucasian man, three months after transaortic valve replacement, was admitted with malaise, generalized weakness, and a 20-pound weight loss over two months. He had a notable history of recurrent Salmonella septicemia but no fever, diarrhea, vomiting, rash, or other classic infectious symptoms. On examination, he appeared cachectic, but vital signs and cardiovascular findings were normal.<br /><br />Initial laboratory studies were largely unremarkable, including a normal white blood cell count and normal renal function. However, blood cultures grew gram-negative rods, and pro-BNP was elevated. Because of his prior Salmonella bacteremia and recent valve replacement, clinicians strongly suspected infective endocarditis and began empiric ceftriaxone. Transesophageal echocardiography later confirmed endocarditis involving the prosthetic aortic valve, and cultures identified Salmonella sensitive to ceftriaxone.<br /><br />The patient remained without leukocytosis throughout hospitalization and improved with a six-week course of ceftriaxone, without requiring surgery. The report emphasizes that Salmonella endocarditis is extremely uncommon, accounting for less than 0.01% of bacterial endocarditis cases, and usually presents with fever and gastrointestinal symptoms. This patient’s absence of typical signs made the diagnosis especially challenging.<br /><br />The authors conclude that clinicians should maintain a high index of suspicion for endocarditis in patients with prosthetic valves, recurrent bacteremia, or other risk factors, even when classic symptoms are absent. They also note that while prosthetic valve endocarditis often warrants surgical replacement, prolonged antibiotic therapy may be a successful alternative in stable patients.

Asset Subtitle

Gaayathri Krishnan

Meta Tag

Author List Gaayathri Krishnan, Ganesh Natarajan, Luis Duharte

Category Clinical Vignettes

Concept Infective Endocarditis

Concept Salmonella Endocarditis

Concept Prosthetic valve endocarditis

Concept Structural Heart Disease

Concept Intravascular Prosthesis

Distinguished Non-Finalist

Presenter Organization AdventHealth - Sebring, FL

Presenting Author Gaayathri Krishnan

Track Adult

Keywords

Salmonella

infective endocarditis

prosthetic aortic valve

transaortic valve replacement

bacteremia

ceftriaxone

transesophageal echocardiography

gram-negative rods

weight loss

prosthetic valve endocarditis

Infective Endocarditis

Salmonella Endocarditis

Prosthetic valve endocarditis

Structural Heart Disease

Intravascular Prosthesis