Tricuspid valve infective endocarditis in a non-IVDU patient with atopic dermatitis

Heerani Woodun; Sarah Bouayyad; Sura Sahib; Nadir Elamin; Steven Hunter; Abdallah Al-Mohammad

doi:10.1093/omcr/omaa045

Tricuspid valve infective endocarditis in a non-IVDU patient with atopic dermatitis

Oxf Med Case Reports. 2020 Jul 24;2020(7):omaa045. doi: 10.1093/omcr/omaa045. eCollection 2020 Jul.

Authors

Heerani Woodun¹, Sarah Bouayyad², Sura Sahib³, Nadir Elamin¹, Steven Hunter⁴, Abdallah Al-Mohammad¹

Affiliations

¹ Cardiology Department, Sheffield Teaching Hospitals, Sheffield S5 7AU, UK.
² ENT Department, Tameside General Hospital, Ashton-Under-Lyne OL6 9RW, UK.
³ Dermatology Department, Doncaster Royal Infirmary, Doncaster DN2 5LT, UK.
⁴ Cardiothoracic Department, Sheffield Teaching Hospitals, Sheffield S5 7AU, UK.

Abstract

A 29-year-old male, with chronic atopic dermatitis (AD), presented with a 2-week history of fatigue, pyrexia and weight loss. Examination showed eczematous patches with lichenified papules, erosions on the right shin and a new murmur. Blood cultures isolated methicillin-sensitive Staphylococcus aureus. Transthoracic echocardiography showed vegetation on the tricuspid valve (TV) that was adherent to the septal leaflet. He was treated for infective endocarditis, attributed to poorly controlled AD, with intravenous Flucloxacillin. Due to ongoing sepsis and pulmonary septic emboli, Clindamycin was added. He underwent TV repair; the septal leaflet was excised, and the remnant two leaflets were brought together with a ring. His patent foramen ovale was closed. His skin was treated with topical steroids and emollients. Right-sided endocarditis of an intact TV is uncommon in a non-intravenous drug user. Therefore, this novel case portrays the importance of aggressively managing AD as it is a risk factor for significant systemic infections.

Keywords: Staphylococcus aureus; atopic dermatitis; eczema; infective endocarditis; tricuspid valve.