Adult bicuspid aortic valve endocarditis with extensive paravalvular invasion attributable to disseminated varicella zoster infection.

We report a previously healthy 21-year-old man who developed disseminated varicella zoster infection complicated with encephalitis, acute renal insufficiency, liver dysfunction, and an apparent pustular skin superinfection with Staphylococcus aureus. He later developed an extensively destructive endocarditis affecting a congenital bicuspid aortic valve, accompanied with leaflet perforation, complete atrio-ventricular (AV) block, and invasion of vegetation to both left and right atrium; the endocarditis was attributed to the same skin pathogen, S. aureus. He underwent radical debridement of the aortic valve, membranous ventricular septum, and mitral anterior fibrous trigone, followed by reconstruction of intracardiac defects with 2 autologous pericardial patches and aortic valve replacement. After a permanent pacemaker implantation and 4 weeks of antibiotic treatment, he was discharged after an uneventful postoperative course.