Abstract

Background: Prosthetic valve endocarditis (PVE) is a serious condition associated with high mortality rate. The causes of PVE vary from surgical procedure to superficial skin infection. Sometimes it is difficult to identify latent infections in the body and recognize them as the true causes of PVE. We describe here a case of PVE complicated by osteomyelitis that was hematogenously disseminated from a disregarded infected skin tumor on the head.

Methods: A 73-year-old man who underwent aortic valve replacement developed prosthetic valve endocarditis complicated by osteomyelitis that was disseminated from an infected skin tumor on the head. During the follow-up after the first operation, neither a small skin mass on the head nor lower back pain had been considered manifestations of infection. With progressive pain and fever, however, the patient was referred back to our hospital for further examination; vegetation and paravalvular leakage around the aortic valve and lumbar osteomyelitis was detected.

Results: A Staphylococcus aureus blood culture confirmed the diagnosis of prosthetic valve endocarditis associated with osteomyelitis, originating from the infected skin tumor. Re-operation was performed. The affected aortic valve was excised through a transverse aortotomy, revealing a deep annular abscess and partial valvular dehiscence. After the abscess was debrided completely, the damaged annulus was reconstructed with an autologous pericardium. For the valve implantation, pledgeted 2-0 mattress sutures were threaded through the aortic root from the outside, considering the potential fragility of the annulus. With multidisciplinary treatment, re-aortic valve replacement by cardiac surgeons, removal of the skin tumor by dermatologists, and intensive antibiotic therapy for osteomyelitis by orthopedists, the patient recovered.

Conclusion: Valve replacement patients are vulnerable to external infective agents, hence awareness should be directed towards the potential threats.

Keywords: Endocarditis, prosthesis, infection, co-morbidity, reoperation