SHM Converge Scientific Abstract ePoster Gallery-Coverage Lost, Consequences Found: Complicated Endocarditis Following a Lapse in Biologic Therapy

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This case describes a patient with severe psoriasis who lost access to biologic therapy because of insurance-related barriers. The lapse led to uncontrolled, extensive skin disease, creating a potential portal of entry for bacteria. The patient developed MSSA bacteremia that persisted despite empiric cefazolin treatment.<br /><br />Initial transthoracic echocardiography was technically difficult and nondiagnostic, but transesophageal echocardiography revealed large, mobile mitral valve vegetations measuring 2.85 x 1.52 cm, confirming native valve infective endocarditis. Brain MRI also showed multiple septic emboli, including an acute infarct in the right centrum semiovale, indicating systemic embolization with central nervous system involvement.<br /><br />The patient was transferred for mitral valve repair due to complicated MSSA native valve endocarditis.<br /><br />Key teaching points emphasized in the report:<br />- Severe, uncontrolled psoriasis can serve as a source of bacteremia.<br />- Persistent MSSA bacteremia should prompt transesophageal echocardiography when TTE is nondiagnostic.<br />- Insurance and medication access barriers are modifiable risk factors that can contribute to serious infectious complications.<br /><br />The case highlights the high morbidity of Staphylococcus aureus endocarditis, the importance of early definitive imaging, and the need for clinicians to consider social and access-related factors when evaluating and managing patients with chronic inflammatory disease.

Asset Subtitle

Rutva Bhatt

Meta Tag

Author List Albana B. Mihali, Rutva Bhatt, Sriman Narain

Category Clinical Vignettes

Concept Psoriasis

Concept MSSA Bacteremia

Concept Native valve infective endocarditis

Concept Bacteremia

Concept Staphylococcus aureus infection

Distinguished Non-Finalist

Presenter Organization Boston University Chobanian & Avedisian School of Medicine

Presenting Author Rutva Bhatt

Track Adult

Keywords

psoriasis

MSSA bacteremia

infective endocarditis

mitral valve vegetations

transesophageal echocardiography

septic emboli

brain MRI

native valve endocarditis

biologic therapy access

insurance barriers

Psoriasis

MSSA Bacteremia

Native valve infective endocarditis

Bacteremia

Staphylococcus aureus infection