Letter to the Editor
Isolated pulmonary native valve infectious endocarditis due to Enterococcus faecalis

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Abstract

We report a case of isolated pulmonary native valve infectious endocarditis due to Enterococcus faecalis in a patient without predisposing factors. The early diagnostic suspicion plays a pivotal role in this entity. An individual clinical and echocardiographic management is mandatory in these patients.

Introduction

Isolated pulmonary native valve infectious endocarditis (PNVIE) is an uncommon clinical entity accounting for 1.5–2.0% of all admissions for infectious endocarditis (IE). Intravenous drug abuse, alcoholism, sepsis, and catheter related infections account for the majority of predisposing factors [1], [2], [3]. In patients without underlying heart diseases, isolated pulmonary IE is extremely rare and only few cases have been previously reported [2], [4].

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Case report

A 57-year-old man patient was hospitalized because of fever of unknown origin and malaise since the last 2 months before admission. The medical history was only remarkable for smoking habit. He related a 8-kg weight loss during the previous 3 months. Before admission the patient was treated with several antibiotics without resolution of fever.

On admission, blood pressure was 110/60 mm Hg and body temperature was 39 °C. Physical examination was unremarkable and in particular, cardiac murmurs

Discussion

PNVIE is an unusual clinical entity associated to tricuspid valve IE in a high proportion of cases [1], [2]. The most common pathogens that are reported in cases of PNVIE are Staphylococcus aureus and coagulase-negative staphylococci [1], [2]. IE due to E. faecalis is a severe entity, often associated with some intestinal or genitourinary diseases [5]. In this regard, only few cases diagnosed with isolated PNVIE due to E. faecalis have been previously reported [2], [4], [6]. In our case, the

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