Background: Culture-negative endocarditis in patients with previous prosthetic valve replacement is a challenging disease with high mortality and poor outcomes. Recurrent paravalvular leakage is a common complication in patients with prosthetic valve but is rarely realized to endocarditis. Objectives: To report a diagnostic strategy for culture-negative endocarditis caused by atypical pathogen in patients with previous prosthetic valve replacement. Patients and Methods: We present a case report about recurrent prosthetic valvular leakage with preoperatively unknown cause. Traditional clinical laboratory for pathogen detection and echocardiography were routinely performed. The patient received aortic and mitral valve replacement and tricuspid annuloplasty. Metagenomic next-generation sequence tests on removal tissue and blood are performed. Results: Preoperative imaging finding of vegetation and blood culture was negative. Metagenomic next-generation sequence tests on resected valve tissue and blood specimens revealed 236 and 154 unique read-pairs aligning to mycoplasma hominis, respectively. Retrospective serological immunofluorescence assay revealed cross-reaction to mycoplasma pneumonia. Haematoxylin-eosin-stained histological section of the mobile vegetation attached to the mitral mechanism prosthesis demonstrated hyalinization in intercellular substance and infiltration of neutrophils, lymphocytes, and plasmocytes, which indicated chronic infective endocarditis. Culture-negative endocarditis were diagnosed by multidisciplinary team. Azithromycin was selected for anti-mycoplasma hominis. The patient made an excellent recovery and repeat transthoracic echocardiography performed at discharge demonstrated a good prosthetic valve function. Conclusion: Culture-negative endocarditis may be a criminal in cryptogenic paravalvular leakage. A multiple-image-technique strategy combined with metagenomic next-generation sequence to patients with recurrent paravalvular leakage are recommended for early diagnosis ant timely antibiotic administration for potential endocarditis.
| Published in | Cardiology and Cardiovascular Research (Volume 6, Issue 4) |
| DOI | 10.11648/j.ccr.20220604.11 |
| Page(s) | 92-96 |
| Creative Commons |
This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
| Copyright |
Copyright © The Author(s), 2022. Published by Science Publishing Group |
Culture-negative Endocarditis, Recurrent Prosthetic Paravalvular Leakage, mycoplasma hominis
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APA Style
Weiteng Wang, Oudi Chen, Lixi Gan, Xin Li, Hongkun Qing, et al. (2022). Recurrent Prosthetic Paravalvular Leakage in Culture-negative Endocarditis Caused by mycoplasma hominis: A Case Report. Cardiology and Cardiovascular Research, 6(4), 92-96. https://doi.org/10.11648/j.ccr.20220604.11
ACS Style
Weiteng Wang; Oudi Chen; Lixi Gan; Xin Li; Hongkun Qing, et al. Recurrent Prosthetic Paravalvular Leakage in Culture-negative Endocarditis Caused by mycoplasma hominis: A Case Report. Cardiol. Cardiovasc. Res. 2022, 6(4), 92-96. doi: 10.11648/j.ccr.20220604.11
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Download@article{10.11648/j.ccr.20220604.11,
author = {Weiteng Wang and Oudi Chen and Lixi Gan and Xin Li and Hongkun Qing and Fanyu Chen and Zuoren Xiao and Xuhua Jian},
title = {Recurrent Prosthetic Paravalvular Leakage in Culture-negative Endocarditis Caused by mycoplasma hominis: A Case Report},
journal = {Cardiology and Cardiovascular Research},
volume = {6},
number = {4},
pages = {92-96},
doi = {10.11648/j.ccr.20220604.11},
url = {https://doi.org/10.11648/j.ccr.20220604.11},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ccr.20220604.11},
abstract = {Background: Culture-negative endocarditis in patients with previous prosthetic valve replacement is a challenging disease with high mortality and poor outcomes. Recurrent paravalvular leakage is a common complication in patients with prosthetic valve but is rarely realized to endocarditis. Objectives: To report a diagnostic strategy for culture-negative endocarditis caused by atypical pathogen in patients with previous prosthetic valve replacement. Patients and Methods: We present a case report about recurrent prosthetic valvular leakage with preoperatively unknown cause. Traditional clinical laboratory for pathogen detection and echocardiography were routinely performed. The patient received aortic and mitral valve replacement and tricuspid annuloplasty. Metagenomic next-generation sequence tests on removal tissue and blood are performed. Results: Preoperative imaging finding of vegetation and blood culture was negative. Metagenomic next-generation sequence tests on resected valve tissue and blood specimens revealed 236 and 154 unique read-pairs aligning to mycoplasma hominis, respectively. Retrospective serological immunofluorescence assay revealed cross-reaction to mycoplasma pneumonia. Haematoxylin-eosin-stained histological section of the mobile vegetation attached to the mitral mechanism prosthesis demonstrated hyalinization in intercellular substance and infiltration of neutrophils, lymphocytes, and plasmocytes, which indicated chronic infective endocarditis. Culture-negative endocarditis were diagnosed by multidisciplinary team. Azithromycin was selected for anti-mycoplasma hominis. The patient made an excellent recovery and repeat transthoracic echocardiography performed at discharge demonstrated a good prosthetic valve function. Conclusion: Culture-negative endocarditis may be a criminal in cryptogenic paravalvular leakage. A multiple-image-technique strategy combined with metagenomic next-generation sequence to patients with recurrent paravalvular leakage are recommended for early diagnosis ant timely antibiotic administration for potential endocarditis.},
year = {2022}
}
TY - JOUR T1 - Recurrent Prosthetic Paravalvular Leakage in Culture-negative Endocarditis Caused by mycoplasma hominis: A Case Report AU - Weiteng Wang AU - Oudi Chen AU - Lixi Gan AU - Xin Li AU - Hongkun Qing AU - Fanyu Chen AU - Zuoren Xiao AU - Xuhua Jian Y1 - 2022/10/21 PY - 2022 N1 - https://doi.org/10.11648/j.ccr.20220604.11 DO - 10.11648/j.ccr.20220604.11 T2 - Cardiology and Cardiovascular Research JF - Cardiology and Cardiovascular Research JO - Cardiology and Cardiovascular Research SP - 92 EP - 96 PB - Science Publishing Group SN - 2578-8914 UR - https://doi.org/10.11648/j.ccr.20220604.11 AB - Background: Culture-negative endocarditis in patients with previous prosthetic valve replacement is a challenging disease with high mortality and poor outcomes. Recurrent paravalvular leakage is a common complication in patients with prosthetic valve but is rarely realized to endocarditis. Objectives: To report a diagnostic strategy for culture-negative endocarditis caused by atypical pathogen in patients with previous prosthetic valve replacement. Patients and Methods: We present a case report about recurrent prosthetic valvular leakage with preoperatively unknown cause. Traditional clinical laboratory for pathogen detection and echocardiography were routinely performed. The patient received aortic and mitral valve replacement and tricuspid annuloplasty. Metagenomic next-generation sequence tests on removal tissue and blood are performed. Results: Preoperative imaging finding of vegetation and blood culture was negative. Metagenomic next-generation sequence tests on resected valve tissue and blood specimens revealed 236 and 154 unique read-pairs aligning to mycoplasma hominis, respectively. Retrospective serological immunofluorescence assay revealed cross-reaction to mycoplasma pneumonia. Haematoxylin-eosin-stained histological section of the mobile vegetation attached to the mitral mechanism prosthesis demonstrated hyalinization in intercellular substance and infiltration of neutrophils, lymphocytes, and plasmocytes, which indicated chronic infective endocarditis. Culture-negative endocarditis were diagnosed by multidisciplinary team. Azithromycin was selected for anti-mycoplasma hominis. The patient made an excellent recovery and repeat transthoracic echocardiography performed at discharge demonstrated a good prosthetic valve function. Conclusion: Culture-negative endocarditis may be a criminal in cryptogenic paravalvular leakage. A multiple-image-technique strategy combined with metagenomic next-generation sequence to patients with recurrent paravalvular leakage are recommended for early diagnosis ant timely antibiotic administration for potential endocarditis. VL - 6 IS - 4 ER -
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