On hospital day 3, the patient developed respiratory distress and hypoxemia due to acute pulmonary edema on CXR (Fig. Antibiotics were changed to ceftriaxone (2 g IV every 24 h) and gentamicin 5 mg/kg/day divided q 8 h. Urine and blood cultures collected on the day of admission grew a pan sensitive strain of P. 2) with moderate mitral regurgitation (Fig. A transthoracic echocardiography revealed a 1.2 × 0.5 cm mobile echogenic density on the anterior leaflet of the MV (Fig. She was admitted to the general medical floor with a diagnosis of cUTI and was started on piperacillin/tazobactam 3.375 g every 8 h as an extended infusion. Her urinalysis had bacteria, nitrite, and leukocyte esterase with only 5 WBCs. 1) and a 4 mm ureteral stone without hydronephrosis. ![]() An abdominal/pelvic CT scan showed evidence of acute/subacute splenic emboli, with wedge-shaped zones of hypoattenuation in the inferior and superior aspects of the spleen (Fig. Within 1 day of admission, patient had temperature of 40 ☌, HR 104 bpm, BP dropping to 103/67 mmHg and white blood cell count increased to 18,480/µL. Her white blood cell count was 11,370/µL. The remainder of the physical exam was normal. Her lungs were clear and there was no appreciable heart murmur noted. She had a temperature of 36.7 ☌, heart rate (HR) of 97 beats per minute and a blood pressure (BP) of 155/86 with a normal lactate level. On admission, she had a complaint of generalized fatigue. Additional studies with larger numbers of Proteus endocarditis cases are needed to investigate an association between immunosuppression and Proteus species endocarditis.Ī 65-year-old female with a history of rheumatoid arthritis on chronic prednisone and scheduled Tofacitinib ER 11 mg q daily, factor V Leiden hypercoagulability, prior saddle pulmonary embolism, and no known valvular heart disease presented to the emergency department following a mechanical fall. mirabilis UTI, ultimately seeding the native MV. We hypothesize that the patient’s immunocompromised status following steroid and Janus Kinase inhibitor usage for rheumatoid arthritis contributed to Gram-negative bacteremia following P. mirabilis was isolated from the surgically removed valve. The patient underwent MV replacement, and P. Transthoracic echocardiography revealed a mobile echogenic density on the anterior mitral valve (MV) leaflet consistent with a vegetation. Blood and urine cultures also grew out P. Complicated UTI was likely secondary to a ureteral stone. ![]() Computed Tomography showed evidence of acute/subacute splenic emboli. Case presentationĪ 65-year-old female with a history of rheumatoid arthritis, factor V Leiden hypercoagulability, and prior saddle pulmonary embolism presented to the emergency department following a mechanical fall. The natural history and treatment of this disease is not as clear but presumed to be associated with complicated urinary tract infection (cUTI). Bacterial infective endocarditis caused by Proteus mirabilis is rare and there are few cases in the literature.
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