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Case Report
 
Mitral valve endocarditis with high level aminoglycoside resistant Enterococcus faecalis in breast cancer patient
Ashish Bhargava1, Vasavi Paidpally2, Pragati Bhargava2
1Infectious Disease Fellow, Department of Medicine, Detroit Medical Center/Wayne State University, Detroit, MI, USA 48071.
2Research Assistant, Division of Infectious Disease, Department of Medicine, Detroit Medical Center/Wayne State University, Detroit, MI, USA 48201.

doi:10.5348/ijcri-2012-09-172-CR-2

Address correspondence to:
Ashish Bhargava, MD, Infectious Disease Fellow
5 Hudson Harper Hospital
540 E Canfield, Detroit
MI. 48201
USA
Phone: 313-745-9649
Email: bashish@med.wayne.edu

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How to cite this article:
Bhargava A, Paidpally V, Bhargava P. Mitral valve endocarditis with high level aminoglycoside resistant Enterococcus faecalis in breast cancer patient. International Journal of Case Reports and Images 2012;3(9):5–8.


Abstract
Introduction: Enterococci represent the third most common cause of infective endocarditis, after streptococcus and Staphylococcus aureus, and are responsible for 5–20% of all cases of endocarditis. We present a rare case of native valve Enterococcus faecalis (E. faecalis) endocarditis of mitral valve in a breast cancer patient.
Case Report: A 56-year-old breast cancer patient presented with complains of fever and found to have E. faecalis bacteremia. Echocardiogram showed mitral valve vegetations. This E. faecalis strain was also found to have high level aminoglycoside resistance (HLAR). She responded well to six weeks ampicillin and ceftriaxone combination therapy despite loss of aminoglycoside synergy.
Conclusion: Most commonly observed risk factors for enterococcal endocarditis were rheumatic fever, valvular heart abnormalities, gastrointestinal neoplasia, surgery (dental surgery, cardiovascular surgery, and abdominal surgery), gastrointestinal procedures and diabetes. Left-sided enterococcal endocarditis in our patient responded well to combination regimen with ampicillin and ceftriaxone despite loss of aminoglycoside synergism.

Key Words: Enterococcus faecalis, Endocarditis, Mitral valve, Breast cancer

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Author Contributions:
Ashish Bhargava – Conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Critical revision of the article, Final approval of the version to be published
Vasavi Paidpally – Conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Critical revision of the article, Final approval of the version to be published
Pragati Bhargava – Conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Critical revision of the article, Final approval of the version to be published
Guarantor of submission:
The corresponding author is the guarantor of submission.
Source of support:
None
Conflict of interest:
Authors declare no conflict of interest.
Copyright:
© Ashish Bhargava et al. 2012; This article is distributed the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any means provided the original authors and original publisher are properly credited. (Please see Copyright Policy for more information.)