Endocarditis by Escherichia Coli: When the Unlikely Happens Endocardite por Escherichia Coli: Quando o Improvável Acontece

Abstract

An 88-year-old male presented with tiredness, diminution of urinary debit and anorexia. The patient was febrile, hypotensive and cardiopulmonary auscultation was normal. Blood-analysis revealed leukocytosis and creatinine 3.1 mg/dL. Urinalysis indicated leukocyturia. The patient was medicated with ciprofloxacin assuming a urinary infection. An Escherichia coli was isolated in urine-microbiology and in 2 samples of blood-culture and antibiotic was changed to meropenem based on antibiogram. Due to constant fever and high inflammatory parameters, an echocardiogram was performed and showed vegetation in mitral valve, so vancomicin and gentamicin were addicted to treatment. Ischemic stroke, with hemorrhagic transformation and left plegia, and a severe perforation of the posterior mitral valve, complicated the clinical course. The overall clinical status gradually improved. A rehabilitation program was set and the patient moved to a rehabilitation unit after 59 days of hospitalization.
This case aims to illustrate how endocarditis is still an entity often difficult to diagnose and is associated with severe complications and requiring prolonged hospitalization.