SHM Converge Scientific Abstract ePoster Gallery-FDG-Pet to Diagnose and Telavancin to Treat Refractory Mssa Endocarditis

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This case describes a 19-year-old woman with fever, nausea, thrombocytopenia, elevated inflammatory markers, and later persistent MSSA bacteremia. Initial evaluation included multiple imaging studies, but the source of infection remained unclear. Repeat transthoracic and transesophageal echocardiography did not definitively identify endocarditis, so FDG-PET/CT was obtained and showed mild FDG avidity near the mitral valve, supporting suspected mitral valve infection/inflammation. The patient also had MRI evidence of small bilateral multifocal infarcts with hemorrhagic conversion, increasing concern for embolic complications from endocarditis.<br /><br />The report highlights two main lessons. First, FDG-PET/CT is not usually the first-line test for native valve endocarditis, but it can be useful when standard imaging such as TEE is inconclusive. Although its sensitivity is limited for native valves, it is now incorporated into the 2023 Duke-ISCVID infective endocarditis criteria and can help identify occult lesions.<br /><br />Second, telavancin was used as an adjunct to oxacillin for refractory MSSA bacteremia. Telavancin is a bactericidal lipoglycopeptide with dual action: inhibition of cell wall synthesis and disruption of the bacterial membrane. In this case, blood cultures cleared within 48 hours after telavancin was started, suggesting potential benefit in persistent staphylococcal bacteremia.<br /><br />Overall, the case supports FDG-PET/CT as a helpful diagnostic tool when endocarditis remains elusive and telavancin as a possible adjunctive therapy in difficult-to-clear MSSA bacteremia.

Asset Subtitle

Allyson Wenner

Meta Tag

Author List Allyson Wenner, Maxwell Bressman MD

Category Clinical Vignettes

Concept PSMA PET/CT

Concept Infective Endocarditis

Concept Methicillin-Susceptible Staphylococcus aureus

Concept Persistent bacteremia

Concept Prosthetic valve endocarditis

Distinguished Non-Finalist

Presenter Organization Greenwich Hospital

Presenting Author Allyson Wenner

Track Adult

Keywords

native valve endocarditis

FDG-PET/CT

MSSA bacteremia

telavancin

oxacillin

transthoracic echocardiography

transesophageal echocardiography

mitral valve infection

embolic infarcts

Duke-ISCVID criteria

PSMA PET/CT

Infective Endocarditis

Methicillin-Susceptible Staphylococcus aureus

Persistent bacteremia

Prosthetic valve endocarditis