Title : A case of late onset prosthetic valve endocarditis with cerebral thrombo-embolic episodes and aseptic meningitis
Abstract:
This case report describes a 57-year-old man with a history of coronary artery bypass grafting (CABG) and mitral valve replacement who presented with fever, rigors, and focal neurological symptoms. The patient was diagnosed with late-onset prosthetic valve endocarditis (PVE) complicated by cerebral thromboembolic episodes and aseptic meningitis. In this presentation, attendees will be guided through a detailed exploration of late-onset prosthetic valve endocarditis (PVE) utilizing a captivating case study as the focal point. The discussion will unravel the intricate nuances of this challenging clinical entity, encompassing diagnostic dilemmas, therapeutic approaches, and clinical ramifications. By dissecting the complexities of late-onset PVE, participants will gain invaluable insights into its pathophysiology, clinical manifestations, and management strategies, equipping them with essential knowledge to navigate this intricate terrain effectively.
The presentation commences by elucidating the clinical presentation of late-onset PVE, emphasizing its protean nature and the diagnostic challenges it poses. Through the analysis of the presented case, attendees will develop a comprehensive understanding of the varied clinical manifestations of late-onset PVE, ranging from fever and rigors to focal neurological deficits. This exploration serves to underscore the importance of maintaining a high index of suspicion for infective endocarditis in patients with prosthetic valves, particularly in the context of atypical presentations.
Subsequently, the discussion delves into the diagnostic workup of late-onset PVE, elucidating the role of various investigative modalities in establishing a definitive diagnosis. Attendees will gain insight into the limitations of conventional diagnostic techniques, such as transthoracic echocardiography, and the pivotal role of transesophageal echocardiography in confirming the presence of vegetations on prosthetic valves.
Moreover, the presentation navigates through the therapeutic landscape of late-onset PVE, addressing the complexities of antibiotic therapy and the potential role of surgical intervention. Attendees will be guided through the rationale behind antibiotic selection, including considerations for antimicrobial coverage and duration of therapy. Furthermore, the discussion will explore the indications and timing of surgical intervention in late-onset PVE, highlighting the importance of a multidisciplinary approach in optimizing patient outcomes.
