Heart & Lung 43 (2014) 161e163
Contents lists available at ScienceDirect
Heart & Lung journal homepage: www.heartandlung.org
Aerococcus christensenii native aortic valve subacute bacterial endocarditis (SBE) presenting as culture negative endocarditis (CNE) mimicking marantic endocarditis Anita Jose, MD a, Burke A. Cunha, MD a, b, *, Natalie C. Klein, MD, PhD a, b, Paul E. Schoch, PhD c a
Infectious Disease Division, Winthrop-University Hospital, Mineola, NY, USA State University of New York, School of Medicine, Stony Brook, NY, USA c Microbiology Laboratory, Winthrop-University Hospital, Mineola, NY, USA b
a r t i c l e i n f o
a b s t r a c t
Article history: Received 29 August 2013 Received in revised form 4 October 2013 Accepted 15 November 2013 Available online 15 December 2013
This is a case report of an adult who presented with apparent culture negative endocarditis (CNE) thought to be marantic endocarditis due to a B-cell lymphoproliferative disorder. This was a most perplexing case and was eventually diagnosed as subacute bacterial endocarditis (SBE) due to a rare slow growing organism. Against the diagnosis of SBE was the lack of fever, hepatomegaly, peripheral manifestations and microscopic hematuria. Also, against a diagnosis of SBE was another explanation for the patient’s abnormal findings, e.g., elevated ferritin levels, elevated a1/a2 globulins on SPEP, an elevated alkaline phosphatase, flow cytometry showing B-lymphocytes expressing CD5, and a bone lesion in the right iliac. Findings compatible with both SBE and marantic endocarditis due to a B-cell lymphoproliferative disorder included an elevated ESR, and splenomegaly. Blood cultures eventually became positive during hospitalization. We report a case of native aortic valve (AV) subacute bacterial endocarditis (SBE) due to Aerococcus christensenii mimicking marantic endocarditis due to a B-cell lymphoproliferative disorder. To the best of our knowledge, this is the first reported case of native AV SBE due to A. christensenii presenting as marantic endocarditis. Ó 2014 Elsevier Inc. All rights reserved.
Keywords: Mimics of endocarditis Slow growing Gram positive cocci B-cell lymphoproliferative disorder Culture negative endocarditis (CNE) Marantic endocarditis Viridans streptococcal endocarditis mimics Elevated ferritin levels Endocarditis differential diagnosis
Introduction Subacute bacterial endocarditis (SBE) is caused by low virulence microorganisms that infect previously abnormal/damaged heart valves. Most patients with SBE are ill for 1e3 months prior to presentation. A subacute/indolent course of SBE is usual with fevers
Contents lists available at ScienceDirect
Heart & Lung journal homepage: www.heartandlung.org
Aerococcus christensenii native aortic valve subacute bacterial endocarditis (SBE) presenting as culture negative endocarditis (CNE) mimicking marantic endocarditis Anita Jose, MD a, Burke A. Cunha, MD a, b, *, Natalie C. Klein, MD, PhD a, b, Paul E. Schoch, PhD c a
Infectious Disease Division, Winthrop-University Hospital, Mineola, NY, USA State University of New York, School of Medicine, Stony Brook, NY, USA c Microbiology Laboratory, Winthrop-University Hospital, Mineola, NY, USA b
a r t i c l e i n f o
a b s t r a c t
Article history: Received 29 August 2013 Received in revised form 4 October 2013 Accepted 15 November 2013 Available online 15 December 2013
This is a case report of an adult who presented with apparent culture negative endocarditis (CNE) thought to be marantic endocarditis due to a B-cell lymphoproliferative disorder. This was a most perplexing case and was eventually diagnosed as subacute bacterial endocarditis (SBE) due to a rare slow growing organism. Against the diagnosis of SBE was the lack of fever, hepatomegaly, peripheral manifestations and microscopic hematuria. Also, against a diagnosis of SBE was another explanation for the patient’s abnormal findings, e.g., elevated ferritin levels, elevated a1/a2 globulins on SPEP, an elevated alkaline phosphatase, flow cytometry showing B-lymphocytes expressing CD5, and a bone lesion in the right iliac. Findings compatible with both SBE and marantic endocarditis due to a B-cell lymphoproliferative disorder included an elevated ESR, and splenomegaly. Blood cultures eventually became positive during hospitalization. We report a case of native aortic valve (AV) subacute bacterial endocarditis (SBE) due to Aerococcus christensenii mimicking marantic endocarditis due to a B-cell lymphoproliferative disorder. To the best of our knowledge, this is the first reported case of native AV SBE due to A. christensenii presenting as marantic endocarditis. Ó 2014 Elsevier Inc. All rights reserved.
Keywords: Mimics of endocarditis Slow growing Gram positive cocci B-cell lymphoproliferative disorder Culture negative endocarditis (CNE) Marantic endocarditis Viridans streptococcal endocarditis mimics Elevated ferritin levels Endocarditis differential diagnosis
Introduction Subacute bacterial endocarditis (SBE) is caused by low virulence microorganisms that infect previously abnormal/damaged heart valves. Most patients with SBE are ill for 1e3 months prior to presentation. A subacute/indolent course of SBE is usual with fevers
