Infective endocarditis (IE) is not common currently. We present such a case with dissemination of septic emboli causing multiple sites of abscess.
A 13 years old boy presented to the emergency department with left gluteal swelling and vomiting. He was not able to walk.. 3 days earlier, he came to the department complaining of backache following accidental wall 5 days earlier but discharged with diagnosis of musculoskeletal pain. Ultrasound in the emergency department showed deep-seated abscess with the size of 1.4x4 cm. This was confirmed by radiologist. Patient was referred to surgery team and incision and drainage were performed. Post-surgery, it was noted that patient had swelling on the right major pectoralis muscle as well as fever. Clindamycin was started and completed for 1 week. Echocardiography was ordered and a vegetation is sees on the tricuspid valve. Blood culture grew Methycillin-sensitive Staphylococcus Aureus. Subsequent CT Thorax, Abdomen and Pelvis showed multiple cavitating lung lesions, nodules and patchy consolidation likely septic pulmonary emboli with iliacus collection and residual left gluteus minimus collection with resolved right pectoralis major intramuscular collection. He was started ton high dose cloxacillin at 12gram daily for 6 weeks. Patient was referred for valve replacement but the surgery will only take place after completion of 6 weeks of antibiotics. He was well during the last follow-up recently (after 4 weeks of discharge)
Discussion & Conclusion
IE is becoming rare these days apart from intravenous drug users. This case has only gluteal abscess prior to the development of infective endocarditis and is the most likely origin. This is a rare case whereby gluteal abscess subsequently precipitates IE which in turn disseminates to multiple places. IE should be considered when multiple sites of abscess occur in a patient and immediate echocardiogram should be done and antibiotics started early.
bacterial, endocarditis, disseminated, infective, heart