Campylobacter fetus prosthetic valve endocarditis presenting as a stroke.

ABSTRACT

INTRODUCTION: Campylobacter is a common pathogen of the gastrointestinal tract, but invasive disease is rare. Campylobacter fetus can play a role in osteomyelitis, meningitis and joint infection and has a prediliction for the vascular endothelium, causing mycotic aneurysms, thrombophlebitis and endocarditis. Here we present a case of prosthetic valve endocarditis caused by C. fetus and a review of the literature. CASE PRESENTATION An 85-year-old woman with a tissue aortic valve replacement and atrial fibrillation was admitted to hospital with tonic-clonic seizures, right-sided hemiparesis, facial droop and hemianopia. Multiple cerebral emboli were seen on magnetic resonance imaging of the brain. Blood cultures grew C. fetus and an echocardiogram showed thickening and restricted movement of the aortic valve, a significant difference from an echocardiogram done 2 months before when the same organism was again isolated in blood cultures. She improved after treatment with 6 weeks of amoxicillin and 2 weeks of synergistic gentamicin for prosthetic valve endocarditis. CONCLUSION: There have only been five previously reported cases of C. fetus prosthetic valve endocarditis and this is the only patient who presented as a stroke. The majority of surviving patients required replacement of the affected valve with only one other patient surviving in the absence of surgery. No guidelines exist on the optimum treatment of C. fetus endocarditis and this case reports adds to the growing literature on the appropriate management for this rare and potentially devastating disease.