Multidisciplinary Managing of Infective Endocarditis in A 40-year-old male with a History of Coarctation of the Aorta Repair and Prosthetic Aortic Valve Replacement

Infective endocarditis (IE) is a serious condition, particularly in patients with congenital heart disease and prosthetic valves, where diagnosis and management are more complex. We present clinical case of 40-year-old male, who underwent repair of aortic coarctation at age seven and subsequently mechanical aortic valve replacement for active IE with multiple periannular abscesses, presented for extended diagnostics after six negative pre-operative blood cultures. Blood culture specimens were collected following established local protocols and in line with professional standards of practice. He received empiric therapy with vancomycin, gentamicin and rifampicin. Despite this, during the fourth postoperative week he developed high-grade fever; serial blood and urine cultures remained sterile and echocardiography revealed no new vegetations. Meropenem was added without improvement, then switched to doxycycline and ceftriaxone given the possibility of rare pathogens responsible for culture-negative IE. The patient defervesced within 24 h. Further diagnostics (trans-esophageal echocardiography and labelled leukocyte scintigraphy) excluded active IE. He completed a six-week antibiotic regimen, was anticoagulated with warfarin, and at discharge had normal prosthetic aortic valve function and satisfactory cardiac parameters.