title: [Endocarditis caused by Propionibacterium acnes -- a diagnostic and therapeutic challenge].
abstract: METHODS
  A 77-year-old man suffered from recurrent peripheral cerebral embolisms five months after aortic valve replacement with a bioprosthesis (SJM Epic 25 mm).
  
  
  METHODS
  MRT scanning of the brain revealed multiple ischemic areas in different vascular territories. Clinical signs of infective endocarditis were missing and markers of infection were only modestly increased. However, transthoracic echocardiography showed elevated pressure gradients across the bioprosthesis. Transesophageal echocardiography detected multiple vegetations suggestive of infective endocarditis. Several anaerobic blood cultures grew Propionibacterium acnes.
  
  
  METHODS
  Infective endocarditis affecting the aortic bioprosthesis and aortic root abscess due to Propionibacterium acnes was diagnosed. During parenteral antibiotic treatment with Amicillin/Sulbactam and Gentamicin full remission developed. Four months later a follow-up transesophageal echocardiography showed a relapse. This time the patient was treated intravenously with penicillin and gentamicin and underwent surgical treatment.
  
  
  CONCLUSIONS
  Cardioembolic events should raise suspicion of infective endocarditis, even if typical clinical signs are absent. Propionibacterium acnes is often grown from blood cultures as a contaminant. Nonetheless, Propionibacterium acnes was the cause of the infective endocarditis. In case of conservative management, close intervals of follow-up transesphageal echocardiography are of importance.
authors: Klinik für Kardiologie, Pneumologie und Angiologie mit Schlaganfallstation, ALB FILS KLINIKEN Göppingen. tanja.drosch@kae.de
authors: T
authors: T
authors: Drosch
authors: M
authors: M
authors: Egle
authors: L
authors: L
authors: Zabel
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004697:Endocarditis, Bacterial / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy*; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy*; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D011425:Propionibacterium acnes; D016459:Prosthesis-Related Infections / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents