Recurrent Bacteremia in the Setting of a Coronary Artery Fistula

Abstract

We present an interesting case of a 31-year-old female with recurrent Staphylococcus lugdunensis bacteremia in the setting of a coronary artery fistula (CAF). Over the course of several months, the patient was admitted to the hospital on three separate occasions with an unclear source of bacteremia. She suffered from numerous complications, including cavitary pneumonia, osteomyelitis, synovitis and septic emboli. On each admission, the patient received intravenous (IV) antibiotic therapy. CT scan of the chest with contrast on the third admission revealed a prominent tortuous vessel coursing from the ascending aorta and main pulmonary artery to the left atrium. Coronary CT angiogram confirmed the presence of a fistula connecting the left circumflex artery to the coronary sinus. Common complications of CAF include infective endocarditis and myocardial ischemia; however, we report a novel case of recurrent bacteremia in the context of an anomalous coronary artery. Two months after diagnosis, surgical closure of the CAF was performed. This case illustrates the importance of utilizing different cardiac imaging modalities in order to diagnose congenital cardiac anomalies in a timely fashion and intervene appropriately.

Mechanical Thrombectomy for Septic Embolism Secondary to Staphylococcus lugdunensis Bacteremia without Infective Endocarditis: A Case Report

“…4,9 Two cases of S. lugdunensis septic embolism in the absence of IE have been reported. 10,11 Ishidou et al 10 reported a patient underwent prolonged antibiotic therapy for a month but decompensated a month after discontinuation, and the conduit, a polytetrafluoroethylene foreign body, was found to be obstructed during autopsy. Shah et al 11 described the patient underwent multiple antibiotic courses for recurrent bacteremia and finally underwent surgical ligation of a coronary artery fistula, which was presumed to be the source of bacteremia, without any further recurrence.…”

“…10,11 Ishidou et al 10 reported a patient underwent prolonged antibiotic therapy for a month but decompensated a month after discontinuation, and the conduit, a polytetrafluoroethylene foreign body, was found to be obstructed during autopsy. Shah et al 11 described the patient underwent multiple antibiotic courses for recurrent bacteremia and finally underwent surgical ligation of a coronary artery fistula, which was presumed to be the source of bacteremia, without any further recurrence. Both cases illustrate the importance of a combination of medical and surgical intervention when appropriate under close monitoring in patients with S. lugdunensis bacteremia, even in the absence of IE.…”

“…Although often harmless, S. lugdunensis can be associated with a relatively high morbidity and mortality [ 4 , 9 ]. Two cases of S. lugdunensis septic embolism in the absence of IE have been reported [ 10 , 11 ]. Ishidou et al [ 10 ] reported a patient underwent prolonged antibiotic therapy for a month but decompensated a month after discontinuation, and the conduit, a polytetrafluoroethylene foreign body, was found to be obstructed during autopsy.…”

Coronary Artery Fistula: A Diagnostic Dilemma

“…Symptoms of CAF range from mild dyspnoea, fatigue, chest discomfort, dizziness, syncope, and angina to severe heart failure, pulmonary congestion and MI, all depending upon the severity of the steal and the shunt pathway. [13][14][15][16] Recent cumulative evidence suggests that fistulas remain asymptomatic in first two decades of life but with advancing age the majority of fistulas become symptomatic, especially in the fifth or sixth decades of life. 13 For age <20 years, only one-fifth of the fistulas are symptomatic, while more than two-thirds of the fistulas are symptomatic after the age of 60 years.…”