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Case Reports in Infectious Diseases
Volume 2016 (2016), Article ID 3639517, 3 pages
http://dx.doi.org/10.1155/2016/3639517
Case Report

Haemophilus parainfluenzae Mural Endocarditis: Case Report and Review of the Literature

1Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA
2Section of Infectious Disease and International Health, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA

Received 26 February 2016; Accepted 8 May 2016

Academic Editor: Larry M. Bush

Copyright © 2016 Luca T. Giurgea and Tim Lahey. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Haemophilus parainfluenzae, which uncommonly causes endocarditis, has never been documented to cause mural involvement. A 62-year-old immunocompetent female without predisposing risk factors for endocarditis except for poor dentition presented with fever, emesis, and dysmetria. Echocardiography found a mass attached to the left ventricular wall with finger-like projections. Computed tomography showed evidence of embolic phenomena to the brain, kidneys, spleen, and colon. Cardiac MRI revealed involvement of the chordae tendineae of the anterior papillary muscles. Blood cultures grew Haemophilus parainfluenzae. The patient was treated successfully with ceftriaxone with resolution of symptoms, including neurologic deficits. After eleven days of antibiotics a worsening holosystolic murmur was discovered. Worsening mitral regurgitation on echocardiography was only found three weeks later. Nine weeks after presentation, intraoperative evaluation revealed chord rupture but no residual vegetation and mitral repair was performed. Four weeks after surgery, the patient was back to her baseline. This case illustrates the ability of Haemophilus parainfluenzae to form large mural vegetations with high propensity of embolization in otherwise normal cardiac tissue among patients with dental risk factors. It also underscores the importance of physical examination in establishing a diagnosis of endocarditis and monitoring for progression of disease.