SUCCESSFUL TREATMENT OF ENDOCARDITIS WITH PRESENTATION IN A KIDNEY TRANSPLANT PATIENT - CASE REPORT

Julijana Usprcov; Angela Kabova Karanfilovik; Vlatko Karanfilovski; Adrijana Spasovska; Aleksandra Canevska Tanevska; Zaklina Shterjova; Galina Severova; Frosina Arnaudova; Aleksandar Jovkovski; Oliver Bushljetikj; Marija Gerakaroska; Sasho Jovev; Irena Rambabova Bushljetikj; Goce Spasovski

Julijana Usprcov University Clinic for Nephrology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia
Angela Kabova Karanfilovik University Clinic for Nephrology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia
Vlatko Karanfilovski University Clinic for Nephrology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia
Adrijana Spasovska University Clinic for Nephrology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia
Aleksandra Canevska Tanevska University Clinic for Nephrology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia
Zaklina Shterjova University Clinic for Nephrology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia
Galina Severova University Clinic for Nephrology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia
Frosina Arnaudova University Clinic for Cardiology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia
Aleksandar Jovkovski University Clinic for Cardiology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia
Oliver Bushljetikj University Clinic for Cardiology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia
Marija Gerakaroska University Clinic for Cardiac Surgery, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia
Sasho Jovev University Clinic for Cardiac Surgery, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia
Irena Rambabova Bushljetikj University Clinic for Nephrology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia
Goce Spasovski University Clinic for Nephrology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia

Abstract

Infective endocarditis (IE) is a serious complication in patients with transplanted kidney, leading to graft loss and a high mortality rate. We present a case of native valve endocarditis in a 51-year-old male with transplanted kidney that had atypical clinical course. The patient experienced prolonged subfebrile temperature with paroxysmal arrhythmia and development of cardio-pulmonary insufficiency. Transthoracic echocardiography (TTE) set the diagnosis of aortic valve vegetation with severe aortic regurgitation and pulmonary edema. We failed to isolate a microbiological agent, but all blood cultures were taken under antibiotic therapy. The patient was treated with surgical replacement of the native aortic valve with mechanical heart valve with significant clinical improvement. Ten days after the intervention, he was discharged with reduced markers of inflammation and proper function of the kidney graft. Immunosuppressive therapy was gradually reinstated. One year later, the patient was clinically stable and with proper graft function. Early diagnostic and therapeutic intervention, particularly intensive antibiotic therapy and surgical management can preserve the patient and the kidney allograft.

Key words: kidney transplantation, endocarditis,cardiac surgery.

References

1.Tamzali Y, Danthu C, Aubry A, Brousse R, Faucher JF, El Ouafi Z, et al. High Mortality and Graft Loss after Infective Endocarditis in Kidney Transplant Recipients: A Case-Controlled Study from Two Centers. Pathogens. 2021 Aug 13;10(8):1023.
2.MartÃn-DÃ¡vila P, FortÃºn J, Navas E, Cobo J, JimÃ©nez-Mena M, Moya JL, Moreno S. Nosocomial endocarditis in a tertiary hospital: an increasing trend in native valve cases. Chest. 2005 Aug;128(2):772-779.
3.Ruttmann E, Bonatti H, Legit C, Ulmer H, Stelzmueller I, Anttreter H et al. Severe endocarditis in transplant recipients-an epidemiologic study. Transplant Int.2005; 18(6):690-696.
4.Paterson DI, Dominguez EA, Chang FY, Snydman DR, Singh N. Infective endocarditis in solid organ transplant recipients. Clin Infect Dis. 1998; 26(3):689-694
5.Ruttmann E, Bonatti H, Legit C, Ulmer H, Stelzmueller I, Anttreter H et al. Severe endocarditis in transplant recipients- an epidemiologic study. Transplant Int. 2005; 18(6):690-696.
6.Abbott KC, Duran M, Hypolite I, Ko CW, Jones CA, Agodoa LY. Hospitalization for bacterial endocarditis after renal transplantation in the United States, J Neprol 2001; 14(5):353-360.
7.Nardi Agmon I, Goldberg E, Cohen E, Krause I. Infective endocarditis in the setting of renal transplantation: Case report and review of the literature. Transpl Infect Dis. 2017 Dec;19(6). doi: 10.1111/tid.12786. Epub 2017 Nov 10. PMID: 28981185.
8.Bishara J, Robenshtok E, Weingerger M, Yeshurum M, Sagie A, Pitlik S. Infective endocarditis in renal transplant recipients. Trans Infective Dis 1999;1:138-143
9.Dâ€™Cunha PT, Daventort DS, Fisher KA, Successful treatment of Staphylococcus aureus bacteria endocarditis in a renal transplant recipients. Transpl Infec Dis 2003; 5:144-146.
10.Abbott KC, Duran M, Hypolite I, Ko CW, Jones CA, Agodoa LY. Hospitalization for bacterial endocarditis after renal transplantation in the United States, J Neprol 2001; 14(5): 353-360.
11.Thompson RL. Lavin B, Talbot GH. Endocarditis due to vancomycin- resistance Enterococcus faecium in an immunocompromised patients: cured by administering combination therapy with quinupristin/dalfopristin and high- dose ampicillin. South Med J. 2003; 96:818-820.
12.Katsoul A, Massad MG. Curren issues in the diagnosis and menagment of blood culture- negative infective and non- infective endocarditis. Ann Torac Surg 2013; 95:1467-1474.
13. Baddour LM, Wilson WR, Bayer AS, Fowler VG Jr, Bolger AF, Levison ME, et al. Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease; Council on Cardiovascular Disease in the Young; Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia; American Heart Association; Infectious Diseases Society of America. Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America. Circulation. 2005 Jun 14;111(23):e394-434.
14.Baddour LM et al. Infective endocarditis: a statement for healthcare proffesionals from the from the committee on Reumatic Fever, Endocarditis and Kawasaki Disease, Concils on Clinical Cardiology, Stroke, Cardiovascular Surgery, Anesthesia, American Heart Association: endorsed by the Infectious Disease Society of America. Circulation. 2005; 111(23):e394-434.
15.Topan A, Carstina D, Slavcovici A, Rancea R, Capalneanu R, Lupse M. Assesment of the Duke criteria for the diagnosis of infective endocarditis after twenty-years. An analysis of 241 cases. Clujul Med. 2015;88(3):321-326.
16.Ioannou P, Alexakis K, Kofteridis DP. Endocarditis in kidney transplant recipients: a systematic review. J Chemother. 2021 Sep;33(5):269-275.