Enterococcus faecalis infective endocarditis in anorexia nervosa complicated by multiorgan failure: a case report.

BACKGROUND

Infective endocarditis is characterized by vegetations on the cardiac valves and can lead to serious complications, including heart failure. Anorexia nervosa is associated with cardiovascular abnormalities. To our knowledge, only five cases of anorexia nervosa requiring valve surgery for infective endocarditis have been reported. Herein, we describe the case of a patient with anorexia nervosa who developed infective endocarditis complicated by severe mitral regurgitation and multiorgan failure. CASE PRESENTATION: A 40-year-old woman with anorexia nervosa (body mass index: 10.5 kg/m2) presented with fatigue and edema. Transthoracic echocardiography revealed severe mitral regurgitation and large vegetations on the mitral valve. Infective endocarditis was suspected, and the patient was admitted. The following day, she developed disseminated intravascular coagulation and multiorgan failure, necessitating emergent surgery. The operation was performed via a median sternotomy, and mitral valve replacement was performed using a bioprosthetic valve. Postoperatively, blood and mitral valve cultures grew Enterococcus faecalis. Empiric vancomycin and meropenem were initiated on postoperative day 0; it de-escalated to ampicillin and ceftriaxone on postoperative day 9 and discontinued on postoperative day 36. The patient developed massive hematochezia and hemorrhagic shock on postoperative day 8. Emergent colonoscopy revealed a hemorrhagic rectal ulcer, and surgical hemostasis was achieved. Recurrent hematochezia occurred whenever oral intake was reintroduced; therefore, a colostomy was performed on postoperative day 34. Her nutritional status improved, and she was discharged on postoperative day 98. To date, no recurrence or re-infection of E. faecalis infective endocarditis has occurred.

CONCLUSIONS

In patients with infective endocarditis and anorexia nervosa, investigating potential infection sources while considering malnutrition-related complications is essential.