SHM Converge Scientific Abstract ePoster Gallery-Methamphetamine, Mrsa, and a Prostate Abscess Precipitate Pulmonic Valve Endocarditis

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A 65-year-old man with methamphetamine use presented after a fall with weakness, back pain, fever, sinus tachycardia, leukocytosis, and MRSA bacteremia. Initial chest and abdominal imaging were unrevealing, and both transthoracic and transesophageal echocardiograms were initially negative for vegetations. He left the hospital against medical advice while cultures remained positive.<br /><br />He returned four days later with persistent leukocytosis and MRSA bacteremia. CT imaging then revealed a 5 x 4 cm left pelvic mass contiguous with the prostate, consistent with a prostatic abscess. He had major risk factors for this condition, including diabetes and IV drug use. Urology performed urgent TURP with drainage of copious purulent material, and infectious disease recommended daptomycin plus ceftaroline.<br /><br />Despite earlier negative echo findings, repeat TEE showed a 1.7 x 0.8 cm echodense mass attached to the anterior leaflet of the pulmonic valve, confirming pulmonic valve endocarditis. This case highlights that pulmonic valve endocarditis is rare and can be difficult to diagnose because right-sided structures are often poorly visualized. It also emphasizes that TEE is more sensitive than TTE, especially when suspicion remains high despite a negative initial study.<br /><br />The patient completed six weeks of IV antibiotics and fully recovered. The authors note that prostatic abscesses are usually caused by gram-negative organisms or Enterococcus, but MRSA is increasingly reported, particularly in patients with diabetes or IV drug use. Treatment of prostatic abscess requires both antibiotics and drainage, preferably via TURP.

Asset Subtitle

Jesse E. Doyle

Meta Tag

Author List Douglas Sheffer, Jesse E. Doyle, Roudi Bachar, Sonali W. Paul

Category Clinical Vignettes

Concept MRSA Bacteremia

Concept Prostate Abscess

Concept Pulmonic Valve Endocarditis

Concept Persistent bacteremia

Concept Infective Endocarditis

Distinguished Non-Finalist

Presenter Organization Indiana University

Presenting Author Jesse E. Doyle

Track Adult

Keywords

MRSA bacteremia

pulmonic valve endocarditis

prostatic abscess

transesophageal echocardiogram

transthoracic echocardiogram

methamphetamine use

diabetes mellitus

intravenous drug use

TURP drainage

daptomycin ceftaroline

MRSA Bacteremia

Prostate Abscess

Pulmonic Valve Endocarditis

Persistent bacteremia

Infective Endocarditis