title: Rare case of simultaneous enterococcal endocarditis and prosthetic joint infection.
abstract: A 59-year-old man was admitted with a 3-month history of daily fevers as well as bilateral knee pain and swelling. Medical history was significant for bilateral knee arthroplasties 4 years prior to admission. Two sets of peripheral blood cultures as well as bilateral knee synovial fluid grew Enterococcus faecalis within 10 hours. Transoesophageal echocardiography revealed aortic and mitral valve vegetations suggestive of infectious endocarditis, with severe regurgitation secondary to large size. The patient's hospitalisation was complicated by acute heart failure, necessitating emergent mitral valve repair and aortic valve replacement, followed shortly thereafter by bilateral total knee arthroplasty resection with placement of antibiotic spacers. He was treated with intravenous penicillin and gentamicin for 4 months and recovered fully. He underwent repeat bilateral knee arthroplasties and was placed on amoxicillin for 6 months postoperatively, with no further evidence of infection.
authors.affiliation: Mayo Clinic Minnesota, Rochester, Minnesota, USA.
authors.forename: Sean I
authors.initials: SI
authors.lastname: Tracy
authors.affiliation: Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Sherry-Ann
authors.initials: SA
authors.lastname: Brown
authors.affiliation: Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: John T
authors.initials: JT
authors.lastname: Ratelle
authors.affiliation: Department of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Anjali
authors.initials: A
authors.lastname: Bhagra
mesh_terms: D017548:Echocardiography, Transesophageal; D004697:Endocarditis, Bacterial / Q000150:complications / Q000188:drug therapy*; D013293:Enterococcus faecalis / Q000302:isolation & purification*; D005839:Gentamicins / Q000008:administration & dosage / Q000627:therapeutic use; D016908:Gram-Positive Bacterial Infections / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010406:Penicillins / Q000008:administration & dosage / Q000627:therapeutic use; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000382:microbiology; D013582:Synovial Fluid / Q000382:microbiology; D016896:Treatment Outcome
chemical_list: D005839:Gentamicins; D010406:Penicillins