Pseudomonas aeruginosa endocarditis of a bioprosthetic aortic valve associated with sigmoid adenocarcinoma in a Non-IVDU Patient

Endocarditis with atypical organisms poses a diagnostic and therapeutic challenge to physicians despite medical and surgical advances. Pseudomonas aeruginosa endocarditis is rare, especially in the absence of intravenous drug use (IVDU). Here, we present a case of non-IVDU, prosthetic aortic valve P. aeruginosa endocarditis associated with sigmoid carcinoma. A seventy five year old gentleman with a bioprosthetic aortic valve presented with pyrexia on and off for six months and a 6 month history of weight loss. Three sets of blood cultures grew pseudomonas Aureginosa. A CT scan was done to find the source of the infection and showed a partially obstructive lesion of the sigmoid colon which was later biopsied and found to be moderately differentiated adenocarcinoma. A Trans-oesophageal echocardiogram (TOE) showed a large 2.7cm mobile mass attached to all three leaflets of the aortic valve. He was started on Augmentin initially and then changed to tazocin and ciprofloxacin. Gentamicin was added in later and the tazocin changed to meropenem. He continued to spike. One month post admission he had a redo aortic valve replacement to a tertiary care center. Despite his redo surgery he continued to spike and continued to grow pseudomonas aureginosa from his blood cultures. He passed away three months post-admission after deteriorating further.