Multisystem Embolic Events From Prosthetic Mitral Valve Endocarditis: A Case Report

TL;DR

A 58-year-old woman with a prosthetic mitral valve developed severe endocarditis with multiple organ embolizations, highlighting the aggressive nature of this condition.

Contribution

This case report highlights the rare occurrence of multisystem embolic events during a single episode of prosthetic valve endocarditis.

Findings

The patient had embolic events in the spleen, right kidney, and superior mesenteric artery.

Despite negative blood cultures, PVE was diagnosed using modified Duke criteria.

The case emphasizes the need for urgent surgical reassessment in such complex presentations.

Abstract

Prosthetic valve endocarditis (PVE) is a severe form of infective endocarditis, associated with high morbidity, mortality, and frequent embolic complications. Embolic events are among its most severe complications, potentially involving major organs such as the brain, spleen, kidneys, and lungs. We report herein the case of a 58-year-old woman with a mechanical mitral valve who presented with fever, constitutional symptoms, and subsequent acute right-sided hemiparesis and dysarthria. Transthoracic and transesophageal echocardiography revealed a large, mobile vegetation on the prosthetic mitral valve. Imaging confirmed multiple systemic emboli involving the spleen, right kidney, and superior mesenteric artery. Blood cultures, including fungal studies, were repeatedly negative, but the diagnosis of PVE was established using the modified Duke criteria. Our patient received empiric intravenous antibiotherapy, resulting in clinical improvement and a reduction in inflammatory markers. Despite favorable medical response, the presence of a large vegetation and multiple embolic events warranted urgent surgical reassessment. The rarity of this case lies in the occurrence of multiple embolic sites during the same episode of endocarditis. It underscores the aggressive nature of PVE, its propensity for multisystemic embolic events, and the critical importance of early diagnosis to optimize patient outcomes.

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