Abstract Details

Title Case Report: Hemorrhagic Septic Emboli Secondary to disseminated Listeria monocytogenes in a Patient with a St. Jude aortic Prosthetic Valve

Topic Infectious Disease

Presentation(s) P8 - Poster Session 8 (11:45 AM-12:45 PM)

Poster/Presentation
Number 4-006

Objective NA

Background An embolism of any etiology comprises 15-70% of all patients who present with acute ischemic stroke. Listeria monocytogenes infective endocarditis (IE) is a rare and serious complication affecting only 8% of patients but has an associated mortality of 37-50%. We present a case of cardioembolic strokes secondary to disseminated Listeria IE on a St. Jude mechanical aortic valve.

Design/Methods

A 63 year-old male presented to an outside hospital with one week history of diarrhea. There was a history of aortic valve repair in 2016 with 25 mm St. Jude prosthetic valve. CT brain and lumbar spine revealed left frontal subarachnoid hemorrhage (SAH), right occipital mass, and lesions in L4-L5. Transesophageal echocardiogram obtained showed a multilobulated vegetation measuring 1.4 x 1.3 cm on P2 of the mitral valve with a secondary oscillating component visualized. An abscess formation is seen with a multilobulated oscillating mass measuring at least 2.0 cm is visualized. MRI brain and head showed scattered hemorrhagic punctate acute infarcts bilaterally; MRI of the spinal axis revealed involvement of multiple T-spine levels and L-spine levels, consistent with disseminated infective endocarditis. Blood cultures previously resulted in Listeria monocytogenes, sensitive to ampicillin and gentamicin. As a Jehovah’s Witness, he initially refused the usage of blood products limiting surgical intervention. Patient ultimately elected hospice care without continuation of antibiotic treatment.

Results NA

Conclusions Although rare, this report establishes the possible but detrimental clinical complications of disseminated Listeria IE. Untreated, risk of continuing infection elevates risk of formation of brain abscesses, meningoencephalitis, and recurrent cerebral infarctions. To date approximately 68 case reports of Listeria endocarditis have been reported; 60% of patients had some type of valve alteration with 33% having had a prosthetic valve. This is the first reported case of hemorrhagic embolic strokes secondary to disseminated Listeria IE with a St. Jude’s prosthetic aortic valve.

Authors/Disclosures
Vi Tran, MD (USA University Hospital) PRESENTER	Dr. Tran has nothing to disclose.
Sang Han, MD (University of South Alabama)	Dr. Han has nothing to disclose.
William A. Kilgo, MD, FAAN	Dr. Kilgo has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. Dr. Kilgo has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion. Dr. Kilgo has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Genentech. Dr. Kilgo has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Biogen.
Rebecca L. Sugg, MD, FAAN (The University of South Alabama Medical Center)	Dr. Sugg has nothing to disclose.
Juan G. Ochoa, MD (University of South Alabama)	Dr. Ochoa has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Compumedics. Dr. Ochoa has stock in EEG Care, LLC. An immediate family member of Dr. Ochoa has stock in EEG Care, LLC.

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