# A Hole in the Heart, a Hole in the Defenses: A Case of Pseudomonas Endocarditis

## TL;DR

A rare case of Pseudomonas endocarditis in an immunocompetent patient highlights the importance of early diagnosis and treatment for better outcomes.

## Contribution

This case report presents an unusual instance of Pseudomonas endocarditis in a patient without traditional risk factors.

## Key findings

- Pseudomonas endocarditis occurred in an immunocompetent patient with no traditional risk factors.
- Despite treatment, significant valve damage and mortality occurred, emphasizing the need for early diagnosis.
- Combination antibiotic therapy and surgical intervention are critical for managing Pseudomonas endocarditis.

## Abstract

Infective endocarditis (IE) is a rare but serious infection of the cardiac endothelium. This case report presents a rare instance of left-sided Pseudomonas aeruginosa endocarditis in an immunocompetent patient without traditional risk factors for IE. Pseudomonas endocarditis is uncommon and usually associated with specific factors. The patient in this case was a 30-year-old male with end-stage renal disease, receiving hemodialysis through a tunneled dialysis catheter, who developed a fever. Blood cultures confirmed P. aeruginosa as the causative agent, which prompted the administration of appropriate antibiotics and the removal of the catheter. However, subsequent imaging revealed significant damage to the mitral valve. Despite timely mitral valve replacement and aggressive medical treatment, the patient’s condition worsened, and he ultimately succumbed to the infection. This case also emphasizes the necessity of timely diagnosis and intervention. In this patient, by the time it was diagnosed and managed, significant mitral valve damage had already occurred. Therefore, it should be considered a differential diagnosis even in patients with no risk factors and should be managed vigorously. Pseudomonas endocarditis is associated with high mortality, and successful treatment often requires a combination of antipseudomonal antibiotics due to the organism’s ability to develop resistance. Surgical intervention, such as valve replacement, is frequently necessary. This case underscores the importance of considering P. aeruginosa infection, even in patients without traditional risk factors for IE. Early diagnosis, appropriate antibiotic therapy, and timely surgical intervention are critical for improving outcomes in Pseudomonas endocarditis cases.