# Native Aortic Valve Endocarditis Secondary to Gastric Antral Vascular Ectasia Manipulation During Endoscopic Argon Plasma Coagulation

## TL;DR

A rare case of heart infection occurred after a stomach procedure to treat a bleeding condition, highlighting the need for careful monitoring.

## Contribution

This paper reports a rare case linking gastric antral vascular ectasia treatment to native aortic valve endocarditis.

## Key findings

- Endoscopic argon plasma coagulation for GAVE led to Staphylococcus epidermidis bacteremia and subsequent endocarditis.
- Early detection of a new cardiac murmur and TEE confirmed the diagnosis of native valve infective endocarditis.
- Treatment with IV vancomycin and repeat TEE monitoring showed improvement in vegetation.

## Abstract

Gastric antral vascular ectasia (GAVE) is an uncommon cause of upper gastrointestinal (GI) bleeds. Due to the high vascularity of the region, transient bacteremia due to manipulation of the GI tract can very rarely cause the translocation of bacteria. We present a rare case in which endoscopic manipulation to treat GAVE led to native valve infective endocarditis (IE). Our patient had a prior history of GAVE and presented with worsening dizziness and shortness of breath (SOB). After an esophagogastroduodenoscopy (EGD) and subsequent argon plasma coagulation (APC) for active preantral bleeding, the patient was noted to have repeated fevers, a new cardiac murmur, and positive blood cultures for Staphylococcus epidermidis, leading to a diagnosis of native infective endocarditis. With high clinical suspicion and early recognition of a new cardiac murmur, a transesophageal echocardiogram (TEE) was key in identifying vegetation. This case highlights the importance of combining history, a physical exam, and diagnostic lab tests and imaging to identify endocarditis. Management included two months of intravenous (IV) vancomycin and repeat TEE for close monitoring of vegetation improvement.