SHM Converge Scientific Abstract ePoster Gallery-Neisseria Gonorrhoeae Endocarditis Complicated by Gerbode's Defect

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This case describes a rare complication of disseminated <strong>Neisseria gonorrhoeae</strong> infection causing <strong>infective endocarditis</strong> with an acquired <strong>Gerbode defect</strong> (a left ventricle-to-right atrium shunt). The patient was a <strong>27-year-old man</strong> with well-controlled <strong>HIV</strong> and <strong>type 1 diabetes</strong> who presented with <strong>fever and tachycardia</strong>. Initial imaging was negative, and he was treated empirically with broad-spectrum antibiotics. Blood cultures later identified <strong>N. gonorrhoeae</strong>, and therapy was narrowed to <strong>ceftriaxone</strong>.

Further evaluation with <strong>TEE</strong> revealed a <strong>1.2 x 0.8 cm aortic valve vegetation</strong> causing <strong>severe aortic insufficiency</strong>. He underwent <strong>aortic valve replacement</strong>, during which an intra-operative TEE demonstrated a <strong>Gerbode defect</strong> and destruction of the right coronary leaflet of the aortic valve. Surgical management included <strong>myectomy</strong> and <strong>debridement of the interventricular septum</strong>. The patient completed <strong>6 weeks of ceftriaxone</strong> and was discharged in stable condition, continuing outpatient follow-up.

The discussion emphasizes that although gonorrhea is a common sexually transmitted infection, <strong>disseminated gonococcal infection</strong> occurs in only <strong>1–3%</strong> of cases, and <strong>gonococcal endocarditis</strong> is even rarer, representing <strong>1–2%</strong> of disseminated infections. Despite its rarity, mortality is high, reported at <strong>19–23%</strong>. Gerbode defects may be congenital or acquired, with <strong>endocarditis</strong> and trauma among acquired causes. There are no clear guidelines for management, making this case clinically notable. The report highlights the importance of considering gonococcal endocarditis in septic patients because rising gonorrhea rates may lead to more severe disseminated complications.

Asset Subtitle

Tony M. Cheng

Meta Tag

Author List Colten Creel, Deya Alkhatib, Eric Dietz, Jesus Avila Vega, Margaret Veers, Nathan A. Summers, Patrick Joseph, Shejuti Paul, Steve Lander, Tony M. Cheng

Category Clinical Vignettes

Concept Neisseria gonorrhoeae

Concept Endocarditis

Concept Gonococcal Endocarditis

Concept Blood Culture

Concept Transesophageal Echocardiography

Distinguished Non-Finalist

Presenter Organization University of Tennessee Health Sciences Center

Presenting Author Tony M. Cheng

Track Adult

Keywords

Neisseria gonorrhoeae

infective endocarditis

Gerbode defect

disseminated gonococcal infection

aortic valve vegetation

ceftriaxone

aortic valve replacement

transesophageal echocardiography

HIV

type 1 diabetes

Neisseria gonorrhoeae

Endocarditis

Gonococcal Endocarditis

Blood Culture

Transesophageal Echocardiography