Infected cardiac myxoma.

A 66-year-old male presenting with low-grade fever and general fatigue was diagnosed as having infected myxoma of the left atrium. Blood cultures grew Streptococcus mitis. He underwent urgent resection and histological examination revealed tumor cells in a mucopolysaccharide matrix and bacterial colonies along with active inflammation. Infected cardiac myxoma is extremely rare; however, it contains a potential risk of arterial embolization and so early diagnosis and urgent surgery should be considered.

The underlying causes of chordae tendinae rupture: a systematic review.

BACKGROUND: The underlying causes of chordae tendinae rupture (CTR) and their frequencies vary. Different publications reached conflicting conclusions due to diverse definitions, different detection measures, and morbidity trends over time. METHODS: Systematic literature review of unselected CTR series and underlying cause frequencies reanalysis. RESULTS: Primary CTR overall rates before and since 1985 remain considerable (52.5% vs. 51.2%), yet median decreased (35% and 14%). Sub-acute endocarditis (SBE) and rheumatic heart disease (RHD) were the most frequent causes before 1985 (54.4% and 42.1%, respectively); since 1985 SBE and RHD have dropped sharply to 37.4% and 24.8%, respectively. Since 1985, mitral valve prolapse (MVP) and myxomatous degeneration (MD) have caused 44.5% and 11.7%, respectively. All other causes were almost not evident. CONCLUSIONS: "Primary CTR" remains significant. MD may be underestimated, as microscopic evaluation was not routinely performed. MD is probably the most frequent underlying cause given it is also the underlying cause of MVP. MVP may be overestimated due to detection criteria and misinterpretation of leaflet prolapse. SBE, frequently coexistent with other underlying causes, may be overestimated either due to detection bias or being a consequence rather than CTR cause. RHD is expected to further decline, following rheumatic fever. Previous significant underlying causes proved to be episodic if at all causative, e.g., blunt chest trauma, generalized connective tissue disorder, ischemic heart disease, and other heart and valvular diseases. CTR can occur in apparently healthy subjects having no atypical appearance and who may be unaware of carrying risk.

[Fever, malaise and new onset mitral valve insufficiency. Subacute Streptococcus bovis mitral valve endocarditis ]. / Fieber, Leistungsknick und neu aufgetretene Mitralinsuffizienz. Subakute Mitralklappen-Endocarditis mitStreptococcus bovis.

A 62-year-old patient with low grade fever, fatigue, arthralgia and newly discovered mitral regurgitation was diagnosed with subacute endocarditis. Streptococcus bovis grew from all six blood culture bottles. Streptococcus bovis is known to be associated with gastrointestinal neoplasias. Therefore a colonoscopy was performed and two polyps were removed. Histological analysis revealed a tubulovillous adenoma and a serrated adenoma. Colonoscopy is mandatory for all patients with Streptococcus bovis endocarditis even without any symptoms for colorectal neoplasia. The significance of Streptococcus bovis for the carcinogenesis of colorectal neoplasias and the possible alternative pathway for colorectal carcinomas through serrated adenomas will be discussed.

Role of Bartonella henselae endocarditis in the nucleation of aortic valvular calcification.

A 6-year-old boy presented with fatigability, shortness of breath, and bulging neck veins. Echocardiography revealed large vegetations, aortic insufficiency, a dilated left ventricle, and bicuspid aortic valve. There was no history of immunocompromise, fevers, or feline exposures. Blood cultures were negative; antibodies against Bartonella henselae were positive. Gentamicin was administered intravenously. Ross procedure was performed and patient was discharged on antibiotics in 5 days. Native valve was thickened by scar and fibrinous vegetations. Warthin-Starry stain demonstrated coccobacilli. Light and ultrastructural morphology, and monoclonal staining implicated B. henselae. Bacterial membranes contain calcium apatite crystals. Antigenic material was present in bacteria and calcified nodules. This case illustrates calcified protobacteria becoming incorporated into scar tissue during endocarditis.

Campylobacter fetus septic arthritis revealing a malignancy.

Campylobacter fetus is a rare cause of bone and joint infection. We report a new case in a patient who also had endocarditis due to the same organism. This type of infection usually occurs in immunocompromised hosts. Investigations in our patient found a cancer of the prostate.

Skin manifestations of subacute bacterial endocarditis. Case report of subacute bacterial endocarditis mimicking Tappeiner's angioendotheliomatosis.

SBE manifests many skin findings including petechiae, splinter hemorrhages of the nails, Osler's and laneway lesions, clubbing of the fingers, and findings suggestive of angiitis. Another case with similar histopathologic findings to those originally described by Tappeiner and Pfleger is described, but with positive blood cultures to corroborate the clinical identification of SBE.