SHM Converge Scientific Abstract ePoster Gallery-Disseminated Mycobacterium Tuberculosis Presenting as Prosthetic Valve Endocarditis With Aortic Root Abscess

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This poster presents a rare case of <strong>tuberculous infective endocarditis</strong> in a 54-year-old man with a prior bioprosthetic aortic valve replacement. He developed several weeks of worsening fatigue, dyspnea, and leg edema, and echocardiography showed <strong>aortic root abscess</strong> and <strong>prosthetic valve rocking</strong>, raising concern for prosthetic valve endocarditis. Despite broad empiric antibiotics, he clinically deteriorated.

His course became complicated by <strong>renal failure, recurrent GI bleeding, pancytopenia, and a diffuse bullous rash</strong>. Skin biopsy showed <strong>leukocytoclastic vasculitis</strong>, and bone marrow biopsy revealed <strong>non-necrotizing granulomas</strong>. Although initial blood cultures were negative, <strong>AFB blood cultures later grew Mycobacterium tuberculosis</strong> on hospital day 23, and one sputum culture was also positive. He was started on anti-tuberculous therapy, but treatment was complicated by liver dysfunction and severe multiorgan decline. Surgery was deferred because of critical illness, and the patient ultimately died.

The discussion emphasizes that <strong>M. tuberculosis is an exceptionally rare cause of infective endocarditis</strong>, often presenting as <strong>culture-negative endocarditis</strong>. Risk factors usually include immunocompromise or pulmonary/disseminated TB, but this patient lacked obvious TB exposure risks or a clear primary focus. The case suggests disseminated TB may have contributed to bone marrow failure and vasculitis. Diagnosis required combining imaging findings with mycobacterial cultures, and newer tests such as <strong>plasma microbial cell-free DNA</strong> may accelerate diagnosis when suspicion is high. Overall, the poster highlights that TB should be considered early in subacute, culture-negative endocarditis, and that optimal management is multidisciplinary, often requiring both <strong>medical therapy and surgery</strong> when feasible.

Asset Subtitle

Robert Cutler

Meta Tag

Author List John Franco, Robert Cutler, Sumera Andleeb

Category Clinical Vignettes

Concept Tuberculosis

Concept Culture-negative endocarditis

Concept Prosthetic Valve Abscess

Concept Aortic Root Abscess

Concept Subacute Endocarditis

Distinguished Non-Finalist

Presenter Organization Wake Forest

Presenting Author Robert Cutler

Track Adult

Keywords

tuberculous infective endocarditis

Mycobacterium tuberculosis

culture-negative endocarditis

prosthetic valve endocarditis

aortic root abscess

prosthetic valve rocking

leukocytoclastic vasculitis

non-necrotizing granulomas

plasma microbial cell-free DNA

anti-tuberculous therapy

Tuberculosis

Culture-negative endocarditis

Prosthetic Valve Abscess

Aortic Root Abscess

Subacute Endocarditis