SHM Converge Scientific Abstract ePoster Gallery-Myxoid Degeneration of the Aortic Valve Masquerading as Blood Culture Negative Infective Endocarditis

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This case describes a 56-year-old man with hypertension and polysubstance use disorder who presented with two weeks of worsening shortness of breath and bilateral leg swelling. He had stopped taking his blood pressure medications and used cocaine and heroin on the day of admission. Initial transthoracic echocardiogram showed mildly reduced ejection fraction (45%), grade 2 diastolic dysfunction, and severe aortic regurgitation, leading to a diagnosis of new heart failure with moderately reduced ejection fraction.<br /><br />Transesophageal echocardiogram revealed a small mobile echodensity on the noncoronary cusp of the aortic valve, raising concern for vegetation, along with possible cusp perforation or prolapse and severe aortic regurgitation. A small mitral valve echodensity was also seen. Because of the echocardiographic findings, substance use history, and reported fever, infective endocarditis was initially suspected.<br /><br />However, the workup did not support infection: blood cultures remained negative, inflammatory markers were low, there was no leukocytosis, and there were no other signs of sepsis. The patient was still treated empirically with antibiotics after dental extractions and evaluation by cardiothoracic surgery for valve replacement. He was discharged to rehabilitation with outpatient follow-up.<br /><br />Two months later, he returned with worsening dyspnea, and repeat echocardiography continued to show severe aortic regurgitation. He ultimately underwent aortic valve replacement. Pathology of the excised valve showed myxoid degeneration with no organism growth, confirming the final diagnosis of myxoid degeneration of the aortic valve causing severe aortic insufficiency.<br /><br />This case highlights that myxoid degeneration of the aortic valve, though uncommon, can mimic blood culture-negative infective endocarditis on imaging and may require surgical pathology for definitive diagnosis.

Asset Subtitle

Heather Wang

Meta Tag

Author List Christine Gerula, Erick Quintana Avilés, Heather Wang

Category Clinical Vignettes

Concept Myxoid Degeneration of the Aortic Valve

Concept Blood Culture-Negative Infective Endocarditis

Concept Aortic Insufficiency

Concept Heart Failure

Concept Surgical Valve Replacement

Distinguished Non-Finalist

Presenter Organization Rutgers New Jersey Medical School

Presenting Author Heather Wang

Track Adult

Keywords

myxoid degeneration

aortic valve

severe aortic regurgitation

aortic insufficiency

heart failure

echocardiogram

infective endocarditis

blood culture-negative

valve replacement

echodensity

Myxoid Degeneration of the Aortic Valve

Blood Culture-Negative Infective Endocarditis

Aortic Insufficiency

Heart Failure

Surgical Valve Replacement