We report the first case of homograft endocarditis caused by Campylobacter jejuni, which was treated successfully with antibiotic therapy and valve replacement. To our knowledge, only two other cases of C. jejuni endocarditis, involving native valves, have been reported in the medical literature.
CASE REPORTIn May 2009, a 46-year-old male born in Morocco and living in The Netherlands for the past 22 years was admitted to the hospital with a 3-month history of recurrent fever and general weakness. The patient also reported night sweats, weight loss, and a dry cough. The symptoms developed after travel to Morocco, where he had experienced an episode of headache, shaking, vomiting, sweating, dizziness, and myalgia but no diarrhea. His past medical history was significant for symptomatic aortic valve stenosis, for which his aortic valve was replaced with a homograft in 2000; grade 2/4 mitral valve insufficiency; and chronic hepatitis C nonresponsive to treatment with (peg)interferon and ribavirin in 1998 and 2002 to 2003. His further medical history included chronic alcohol abuse, depression, and chronic tension headache. A routine transthoracic echocardiogram performed in the outpatient clinic a week before admission showed severe aortic homograft and mitral valve insufficiency.On physical examination on admission, the patient's temperature was 37.9°C and later that day it climbed to 40.0°C; his pulse was 100 beats per min, and his blood pressure was 116/58 mm Hg. Cardiac examination revealed a grade 3/6 systolic souffle and a grade 4/6 diastolic souffle, with no clear increase in intensity compared to that heard in earlier auscultations. There were no Janeway lesions, Osler's nodes, conjunctival hemorrhages, or signs of arterial emboli or septic pulmonary emboli. Laboratory tests showed a C-reactive protein level of 149 mg/liter, a leukocyte count of 7.2 ϫ 10 9 /liter with normal differentiation and a hemoglobin level of 7.1 mmol/liter. His chest X-ray was normal, and auramine staining of his stomach fluid and a test for antibodies to HIV were negative. On transesophageal echocardiography, new severe aortic homograft insufficiency was found, together with partial aortic valve destruction and dehiscence and mitral valve insufficiency. Artificial valve vegetation could not be ruled out. Blood cultures were taken, and empirical intravenous treatment with vancomycin, gentamicin, and rifampin for homograft endocarditis was started. Blood cultures taken on the day of admission became positive after 4 days. The Gram stain showed slightly curved Gram-negative rods which were oxidase, catalase, hippurate, and indoxyl acetate positive, corresponding to Campylobacter jejuni. The isolate was sensitive to clarithromycin, ciprofloxacin, and tetracycline by the disk diffusion method (Oxoid, Basingstoke, United Kingdom). The MIC of imipenem was 0.125 mg/liter, as determined by Etest (bioMérieux, Marcy l'Etoile, France) on Mueller-Hinton agar (Becton Dickinson, Heidelberg, Germany) with 5% sheep blood. Vancomycin, gentamicin, and ...
