Detached mechanical prosthesis due to Brucella endocarditis

Abstract

Bu yazıda, ameliyat öncesi antibiyotik tedavisini takiben agresif cerrahi debridman ile başarılı bir şekilde tedavi edilen, Brusella endokarditine bağlı mekanik kapak ayrıl-ma olgusu sunuldu.Anah tar söz cük ler: Brusella hastalığı; endokardit; cerrahi.In this article, we report a case of detached prosthetic valve due to Brucella endocarditis, which was successfully treated with aggressive surgical debridement following preoperative antibiotic treatment.Keywords: Brucellosis; endocarditis; surgery.Brucella endocarditis (BE) is a rare complication of brucellosis, but it is the primary cause of mortality related to this disease. Brucella appears to be a slowly destructive organism with a marked tendency toward tissue ulceration and the development of large vegetations. In addition, it is difficult to eradicate with medical therapy alone.[2] To achieve a cure, removal and replacement of the infected tissue or prosthetic material has been recommended along with long-term antibiotic treatment.[2]Herein, we present a patient with a detached prosthetic valve due to BE who was successfully treated with aggressive surgical debridement following preoperative antibiotic treatment. CASE REPORTA 51-year-old male with a history of aortic valve replacement was admitted to the hospital with a fever that had lasted for two weeks along with weakness and polyarthralgia.His vital signs, except for an elevated body temperature, were normal, and a 2/6 degree diastolic murmur was present on the left sternal border. Although he had moderate pretibial edema, there were no clinical signs of congestive heart failure.His erythrocyte sedimentation rate (ESR) (74 mm/h) and C-reactive protein (CRP) level (16 mg/dL) were elevated, but his leukocyte count was normal. Except for decreased serum protein and albumin levels (total protein: 4.86 g/dL and albumin: 2.12 g/dL), all of the laboratory test results were within normal ranges.Transthoracic (TTE) and transesophageal echocardiography (TEE) revealed a dense and bright mobile mass (vegetation) on the entire surface of the posterior leaflet of the prosthetic aortic valve. Additionally, we observed another vegetation stuck to the subaortic portion of the interventricular septum (Figure 1 and 2). The maximum and mean aortic gradients were 38 mmHg and 25 mmHg, respectively, and second-to third-degree aortic insufficiency was present.After positive blood cultures and Brucella agglutination tests (>1/1280), rifampicine, cotrimoxazole, and tetracycline were administered. The patient was then followed up with weekly echocardiography and blood cultures. After two weeks of this treatment and negative blood cultures, he was then scheduled for surgery.During the reoperation, a totally detached aortic prosthesis was observed with a large vegetation attached to it. The infected mechanical prosthesis (Figure 1)