title: Streptococcus agalactiae infective endocarditis with large vegetation in a patient with underlying protein S deficiency.
abstract: We present a case of a patient with underlying protein S deficiency who suffered from infective endocarditis with a large anterior mitral leaflet (AML) mass of approximately 4.5 cm in length. Intraoperative transesophageal echocardiography (TEE) revealed the mass at the AML base and a rupture of the posterior mitral leaflet chordae tendinae. The vegetation's large size may have been caused by one or more of three factors: location, underlying disease, and the microorganism causing infection. Patients with protein S deficiency are prone to thromboembolic events during cardiac surgery. Infective endocarditis caused by Streptococcus agalactiae usually has a poor prognosis, and, thus, early surgery is recommended.
authors.affiliation: Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan, Republic of China.
authors.forename: H-L
authors.initials: HL
authors.lastname: Cheng
authors.forename: W-C
authors.initials: WC
authors.lastname: Lin
authors.forename: P-Y
authors.initials: PY
authors.lastname: Shih
authors.forename: C-H
authors.initials: CH
authors.lastname: Huang
authors.forename: Y-C
authors.initials: YC
authors.lastname: Hsu
authors.forename: J-C
authors.initials: JC
authors.lastname: Yie
authors.forename: S-Y
authors.initials: SY
authors.lastname: Chen
authors.forename: C-P
authors.initials: CP
authors.lastname: Lin
mesh_terms: D000369:Aged, 80 and over; D017548:Echocardiography, Transesophageal; D004697:Endocarditis, Bacterial / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D006801:Humans; D008944:Mitral Valve Insufficiency / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D018455:Protein S Deficiency / Q000150:complications*; D013290:Streptococcal Infections / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D016896:Treatment Outcome