A rare case of De novo mitral valve endocarditis in a patient with chronic kidney disease

Abstract

In the era of guideline based practice, central catheter induced endocarditis is not unknown. The internal jugular cannula, often serve as conduits for infection of the seemingly normal heart. Our patient is a 60 years old male of chronic kidney disease, stage V, awaiting the maturation of the AV fistula. His presenting complaints were of progressive shortness of breath and fever of one-week duration and he had been receiving cycles of haemodialysis since the last 2months via an indwelling central venous catheter (Internal Jugular Vein). Bedside transthoracic ECHO showed a large posterior mitral leaflet vegetation, mild to moderate mitral regurgitation and normal LV systolic function. Klebsiella pneumonia was grown in the blood culture and the patient was put on Cefoperazone. The patient improved with antibiotics but sought premature discharge due to personal reasons and was lost to follow up. This case is being presented to highlight that a high index of suspicion of infective endocarditis is necessary for patients on cannulas, who develop the febrile illness. Further, unless there is a septal defect, right sided endocarditis was more common when the heart was structurally normal in immune compromised persons, in cannula acquired infection the left heart valves are more often the seat of endocarditis than the right heart valves, as was in our case.