Successful Treatment of Nocardia Farcinica Prosthetic Valvular Endocarditis without Valvular Replacement

Margret Jona Einarsdottir^1, , Hildur Gudmundsdottir², Bjarni Torfason^{1, 3}, Anna Thorisdottir¹, Karl Andersen^{1, 3}, Thordis Jona Hrafnkelsdottir^{1, 3} and Sigurdur Gudmundsson^{1, 3}

¹Landspitali University Hospital, Reykjavik, Iceland

²Hisøy Legesenter, Kolbjørnsvik, Norway

³Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland

Cite this paper

Margret Jona Einarsdottir, Hildur Gudmundsdottir, Bjarni Torfason, Anna Thorisdottir, Karl Andersen, Thordis Jona Hrafnkelsdottir and Sigurdur Gudmundsson. Successful Treatment of Nocardia Farcinica Prosthetic Valvular Endocarditis without Valvular Replacement. American Journal of Medical Case Reports. 2015; 3(5):121-125. doi: 10.12691/AJMCR-3-5-1

Abstract

We report a case of prosthetic valve nocardia endocarditis. A 43 year old farmer underwent aortic valve replacement with a bioprosthetic valve. The immediate post-operative course was uneventful but 2 weeks later he developed fever. A trans-oesophageal echocardiogram (TEE) showed a string like structure attached to the prosthetic valve. Blood cultures grew N. farcinica. He was initially treated with trimethoprim/sulfamethoxazole (TMP/SMZ), but due to eosinophilia and leucopenia his treatment was changed to imipenem and amikacin. He developed a rash, presumed to be due to imipenem, which was then substituted with linezolid. He completed a 6 week course of intravenous (i.v.) antibiotics. Desensitization with amoxicillin/clavulanic acid was successful and the patient received oral amoxicillin/clavulanic acid for 6 months. At present, 12 months from diagnosis, he is afebrile and TEE is normal. To our knowledge, this case is the fifth reported case of successful treatment of prosthetic valve nocardia endocarditis treated without surgery.

Keywords

prosthetic valve, endocarditis, Nocardia farcinica

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

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