title: Are we missing anaerobic infective endocarditis in some acute coronary syndromes?
abstract: A 76-year-old man presented with a 3-week history of intermittent fevers and dyspnoea on exertion after a dental bridge placement 2 months ago. The patient's medical history was significant for mild to moderate mitral valve prolapse. Initial evaluation was notable for a 3/6 systolic apical murmur. Laboratory investigations revealed leucocytosis and elevated erythrocyte sedimentation rate, C reactive protein and cardiac biomarkers. Patient was treated initially for non-ST elevation myocardial infarction. A 2-dimensional echocardiography was concerning for a new mitral regurgitation and a questionable vegetation adjacent to the mitral valve annulus. Transoesophageal echocardiography study confirmed the diagnosis. Subsequent microbial identification was notable for Peptostreptococci and he was started on intravenous penicillin therapy. The unexplained illness with underlying valve disease prompted consideration of infective endocarditis. This case describes a rare occurrence of anaerobic endocarditis imitating an acute coronary event.
authors.affiliation: Department of Internal Medicine, Creighton University Medical Center, Omaha, Nebraska, USA.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Abuzaid
authors.affiliation: Department of Cardiology, Creighton University Medical Center, Omaha, Nebraska, USA.
authors.forename: Aiman
authors.initials: A
authors.lastname: Smer
authors.affiliation: Department of Internal Medicine, Creighton University Medical Center, Omaha, Nebraska, USA.
authors.forename: Halis Kaan
authors.initials: HK
authors.lastname: Akturk
authors.affiliation: Department of Infectious Disease, Creighton University Medical Center, Omaha, Nebraska, USA Department of Infectious Disease, Veterans Affair Hospital, Omaha, Nebraska, USA.
authors.forename: Marvin
authors.initials: M
authors.lastname: Bittner
mesh_terms: D054058:Acute Coronary Syndrome / Q000209:etiology*; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002443:Ceftriaxone / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D017548:Echocardiography, Transesophageal; D004697:Endocarditis, Bacterial / Q000000981:diagnostic imaging* / Q000188:drug therapy; D016908:Gram-Positive Bacterial Infections / Q000000981:diagnostic imaging* / Q000188:drug therapy; D006801:Humans; D008297:Male; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging*; D009203:Myocardial Infarction / Q000175:diagnosis; D010462:Peptostreptococcus; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin; D002443:Ceftriaxone