title: Native quadruple-valve endocarditis caused by Enterococcus faecalis.
abstract: We report the case of a patient with postoperative, hospital-acquired, quadruple-valve endocarditis caused by Enterococcus faecalis on presumed normal native valves. During a cervical laminectomy, the patient had a non-ST-elevation myocardial infarction that was treated conservatively. In the intensive care unit, the patient became febrile and developed a new 2/6 systolic murmur. Blood cultures grew E. faecalis, and the patient was given antibiotics. Postoperative transthoracic echocardiography and transesophageal echocardiography revealed vegetations on all 4 heart valves. Subsequently, the patient was moved to another facility and died. No autopsy was performed. E. faecalis is the third-most-common cause of bacterial endocarditis overall; however, it is rarely found in multiple-valve, hospital-acquired endocarditis. Although transthoracic echocardiography is a powerful diagnostic tool, transesophageal echocardiography increases the sensitivity and specificity to about 90%. In our patient, the diagnosis of native quadruple-valve endocarditis would not have not been made without the use of transesophageal echocardiography.
authors.affiliation: Section of Cardiology, Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana 71130, USA. pkrake@hotmail.com
authors.forename: Patrick R
authors.initials: PR
authors.lastname: Krake
authors.forename: Fahim
authors.initials: F
authors.lastname: Zaman
authors.forename: Neeraj
authors.initials: N
authors.lastname: Tandon
mesh_terms: D003428:Cross Infection / Q000382:microbiology; D004697:Endocarditis, Bacterial / Q000209:etiology*; D013293:Enterococcus faecalis / Q000302:isolation & purification* / Q000472:pathogenicity; D017809:Fatal Outcome; D016908:Gram-Positive Bacterial Infections / Q000150:complications*; D006349:Heart Valve Diseases / Q000209:etiology / Q000382:microbiology*; D006801:Humans; D007796:Laminectomy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D013530:Surgical Wound Infection / Q000150:complications / Q000382:microbiology