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An unusual case of Streptococcus pyogenes infective endocarditis demonstrating the usefulness of repeated echocardiography

Hirdman, Gabriel LU ; Roijer, Anders LU ; Paulsson, Magnus LU orcid ; Wierup, Per LU and Rasmussen, Magnus LU orcid (2026) In IDCases 44. p.1-4
Abstract
Infective endocarditis (IE) is most often caused by alpha-hemolytic streptococci or Staphylococcus aureus and is characterized by the presence of vegetations on the heart valves. Here we present a case of IE caused by Streptococcus pyogenes, a distinctly uncommon IE-pathogen, where no vegetations could be visualized on repeated echocardiography. Diagnosis was instead evident from septic embolizations and progressive aortic insufficiency and IE was verified upon heart valve surgery. The patient was a 69-year-old man who presented with a two-day-history of fever and confusion. Several lesions on the skin and in the brain were suggestive of septic embolization and blood cultures grew S. pyogenes of sequence type 39, emm4. The patient... (More)
Infective endocarditis (IE) is most often caused by alpha-hemolytic streptococci or Staphylococcus aureus and is characterized by the presence of vegetations on the heart valves. Here we present a case of IE caused by Streptococcus pyogenes, a distinctly uncommon IE-pathogen, where no vegetations could be visualized on repeated echocardiography. Diagnosis was instead evident from septic embolizations and progressive aortic insufficiency and IE was verified upon heart valve surgery. The patient was a 69-year-old man who presented with a two-day-history of fever and confusion. Several lesions on the skin and in the brain were suggestive of septic embolization and blood cultures grew S. pyogenes of sequence type 39, emm4. The patient developed progressive aortic insufficiency and was subjected to surgery at day seven after admittance. The aortic cusp showed signs of destructive IE and analysis of the valve demonstrated the presence of DNA from S. pyogenes ultimately confirming the diagnosis. The patient received a biological heart valve prosthesis and needed medical treatment for atrial fibrillation and heart failure post operatively. There was no relapse at six months post-surgery. (Less)
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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
IDCases
volume
44
article number
e02539
pages
1 - 4
publisher
Elsevier
external identifiers
  • scopus:105031810304
ISSN
2214-2509
DOI
10.1016/j.idcr.2026.e02539
language
English
LU publication?
yes
id
ef5f9533-ab03-499d-9afc-3ea678d93106
date added to LUP
2026-03-11 08:48:47
date last changed
2026-03-12 04:01:15
@article{ef5f9533-ab03-499d-9afc-3ea678d93106,
  abstract     = {{Infective endocarditis (IE) is most often caused by alpha-hemolytic streptococci or Staphylococcus aureus and is characterized by the presence of vegetations on the heart valves. Here we present a case of IE caused by Streptococcus pyogenes, a distinctly uncommon IE-pathogen, where no vegetations could be visualized on repeated echocardiography. Diagnosis was instead evident from septic embolizations and progressive aortic insufficiency and IE was verified upon heart valve surgery. The patient was a 69-year-old man who presented with a two-day-history of fever and confusion. Several lesions on the skin and in the brain were suggestive of septic embolization and blood cultures grew S. pyogenes of sequence type 39, emm4. The patient developed progressive aortic insufficiency and was subjected to surgery at day seven after admittance. The aortic cusp showed signs of destructive IE and analysis of the valve demonstrated the presence of DNA from S. pyogenes ultimately confirming the diagnosis. The patient received a biological heart valve prosthesis and needed medical treatment for atrial fibrillation and heart failure post operatively. There was no relapse at six months post-surgery.}},
  author       = {{Hirdman, Gabriel and Roijer, Anders and Paulsson, Magnus and Wierup, Per and Rasmussen, Magnus}},
  issn         = {{2214-2509}},
  language     = {{eng}},
  month        = {{01}},
  pages        = {{1--4}},
  publisher    = {{Elsevier}},
  series       = {{IDCases}},
  title        = {{An unusual case of Streptococcus pyogenes infective endocarditis demonstrating the usefulness of repeated echocardiography}},
  url          = {{http://dx.doi.org/10.1016/j.idcr.2026.e02539}},
  doi          = {{10.1016/j.idcr.2026.e02539}},
  volume       = {{44}},
  year         = {{2026}},
}