INTERESTING CASE OF PULMONIC VALVE ENDOCARDITIS WITH SUBTLE TRANSESOPHAGEAL ECHOCARDIOGRAM FINDINGS

TOPIC: Cardiovascular Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Infective endocarditis (IE) is a rare infection associated with high morbidity and mortality. Left-sided IE cases continue to outweigh the number of right-sided (RSIE) cases. 90% RSIE involve tricuspid valve (1). Staphylococcus species remains most prevalent cause all IE(2). Imaging choice for transthoracic echocardiogram (TTE), given proximity infected structures. However, prevalence isolated pulmonic rare, likely related difficulty in identifying it via TTE(1). The management involves IV antibiotics surgical intervention when indicated. case presented here unique setting pancreatitis. CASE PRESENTATION: An 85-year-old female from an outside facility septic concerns obstructive Blood cultures revealed methicillin-susceptible aureus (MSSA). patient denied any history drug use, prior endocarditis, or recent travels. She was started on cefazolin repeat surveillance blood later were negative. Given no clear source infection, TTE obtained, which negative valvular vegetations. A transesophageal (TEE) 7x9mm oscillating mass at left cusp ultimately confirmed focused TTE. eventually completed six weeks antibiotics. DISCUSSION: 10% approximated be right-sided, out only have involvement(1). often presents nonspecific constitutional symptoms; however, can also present late systemic diseases such as pulmonary embolism infarction, empyema, heart failure. Risk factors include implantable cardiac devices/intravascular devices, anomalies. Our had none these risk factors. etiology could not identified our would been early she Interestingly, TTE, imaging RSIE, initially failed show vegetation. It seen TEE This demonstrates that smaller vegetations easily missed if actively considering endocarditis. CONCLUSIONS: lack symptoms subtle findings. patient's diagnosed acute illness due another cause. has potential severe consequences delayed diagnosis. Thus, efforts should made thoroughly analyze valves index suspicion IE. REFERENCE #1: Shmueli H, Thomas F, Flint N, Setia G, Janjic A, Siegel RJ. Right-Sided Endocarditis 2020: Challenges Updates Diagnosis Treatment. J Am Heart Assoc. 2020 Aug 4;9(15):e017293. #2: Selton-Suty C, Célard M, Le Moing V, Doco-Lecompte T, Chirouze Iung B, Strady Revest Vandenesch Bouvet Delahaye Alla Duval X, Hoen B; AEPEI Study Group. Preeminence infective endocarditis: 1-year population-based survey. Clin Infect Dis. 2012 May;54(9):1230-9. DISCLOSURES: No relevant relationships by Julie Alexander, source=Web Response Nicholas Nguyen, Adhish Singh,