Septic pulmonary emboli from mitral valve endocarditis in a patient with repaired tetralogy of fallot

Abstract

A 37-year-old woman with a past medical history significant for congenital deafness and surgically repaired Tetralogy ofFallot presented with three day history of nausea, vomiting, fever, chills, dyspnea, and lower extremity weakness and physicalexamination notable for Janeway lesions. Peripheral blood and urine cultures were positive for methicillin sensitive Staphlococcusaureus. Transesophageal echocardiogram was consistent with mitral valve endocarditis. Computed tomography images of thechest, abdomen and pelvis demonstrated septic emboli to multiple organs including lungs, liver, spleen and kidneys. Salinecontrast study was negative for a patent foramen ovale, or residual ventricular septal defect. Thus, effectively ruling out left toright intracardiac shunt as the cause of pulmonary septic emboli from mitral valve endocarditis. Moreover, cardiac MRI did notshow any evidence of right sided endocarditis. Therefore, we believe the source of septic pulmonary emboli from mitral valveendocarditis to be through the bronchial arteries. The extent of septic emboli to various organs and the precise mechanism ofpulmonary emboli from left sided endocarditis in a patient with surgically altered cardiac anatomy make this case unique.