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Native Valve Escherichia Coli Endocarditis Following Acute Cholecystitis
Uzma Malik1, Mahdis Solhjoo1, Theresa Henson1, Santosh Kale1, Sara Malik1, Tabassum Yasmin2, Amgad Makaryus3. 1Medicine, Nassau University Medical Center, East Meadow, New York, United States, 2Infectious Disease, Nassau University Medical Center, East Meadow, New York, United States, 3Cardiology, Nassau University Medical Center, East Meadow, New York, United States

Purpose of Study Infective endocarditis (IE) is often associated with known valvular heart disease. The most common organisms in IE are gram positive bacteria and IE caused by gram negative non-HACEK bacteria (species other than Haemophilus species, Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, Kingella species) is uncommon. Escherichia coli (E.coli) does not have the tendency to stick to the native heart valves as easily as the gram positives. Therefore IE caused by E.coli is rare and usually involves the prosthetic valves. Some risk factors for E.coli IE are advanced age, diabetes, female gender, prosthetic heart valve, and urinary tract infection.
Methods Used No method
Summary of Results An 89 year old male with the past medical history of atrial fibrillation, coronary artery disease and hypertension presented to the emergency room with lethargy and mild abdominal discomfort. On examination, he was febrile, the cardiac rhythm was irregularly irregular without any murmurs on auscultation and there was a mild abdominal tenderness in the right upper quadrant. Blood work was unremarkable except for mild leukocytosis. Electrocardiography revealed atrial fibrillation and right bundle branch block. Abdominal ultrasound revealed acute cholecystitis and blood culture grew E.coli. Transthoracic echocardiogram revealed ejection fraction of 50%, regional wall motion abnormalities, mild mitral, tricuspid and aortic valves regurgitation and a small mobile vegetation on the mitral valve.
Patient started on Ceftriaxone and got treatment for total of four weeks. His symptoms and clinical status improved steadily without any surgical interventions.
Conclusions Our case report emphasises the considerable risk of complications with concurrent infections at different sites. Although E.coli IE is very rare and often occurs after urosepsis but as we reported in our case, gallbladder can also be the source of infection in acute cholecystitis.
Therefore it would be wise for the clinicians to consider the development of IE in the setting of gram negative non-HACK bacteremia, even in the patients with native valve and with no risk factors.


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