Abstract
Since the advent of the pneumococcal vaccine, cases of infective endocarditis (IE)
from Streptococcus pneumoniae have become rare. Pneumococcal endocarditis (PE) may be the initial presentation
in Austrian syndrome, which is very lethal. PE needs early detection and treatment
and more commonly develops from pneumonia. To our knowledge, this is the first report
of PE caused by sinusitis after pneumococcal vaccination. Here, a 71-year-old male
presented with low back pain and right ankle joint pain. He had no dental history
or pneumonia and received a pneumococcal vaccine 2 years prior. Blood tests showed
high inflammatory response. We suspected IE due to the high inflammatory response
and oligoarthritis. Transthoracic echocardiography showed vegetation at the aortic
valve. As IE was probable, empiric antibiotic therapy was promptly initiated. Blood
cultures detected S. pneumoniae. IE was diagnosed based on Duke's diagnostic criteria. After starting antibiotic
treatment, lumbar magnetic resonance imaging (MRI) showed an abscess in the right
erector spinae. Cranial MRI showed bilateral maxillary sinusitis. Sinusitis was considered
the possible initial focus of infection. IE should be considered a differential in
patients with S. pneumoniae detected in blood cultures without pneumonia even after pneumococcal vaccination
as PE sometimes follows a fatal course.
<Learning objective: Pneumococcal endocarditis (PE) is rare and can be fatal when there is diagnostic
delay. It may be less likely to exhibit characteristic skin lesions of infective endocarditis
(IE). Clinicians should include IE in the differential diagnoses for cases of Streptococcus pneumoniae detected in blood cultures without pneumonia. Transthoracic echocardiography is also
useful for early detection and treatment of PE.>
Keywords
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Article info
Publication history
Published online: December 08, 2021
Accepted:
November 8,
2021
Received in revised form:
September 10,
2021
Received:
January 4,
2021
Identification
Copyright
© 2022 Published by Elsevier Ltd on behalf of Japanese College of Cardiology.
