Substantial Myocardial Abscess in an Immunocompromised Patient: Fatal Outcome After Coagulase-negative Staphylococcal Native Valve Infection

We present the fatal case of a patient with a 3-month history of malaise, fatigue, low-grade fever and increasing signs of heart failure. Because of a sudden loss of sight and elevated sedimentation rate, arteritis temporalis was mistakenly suspected and treatment with high dose prednisolone was initiated. Five weeks later the patient presented with worsening of symptoms and septicemia with coagulase negative staphylococcus (CoNS). Transesophageal echocardiography revealed a left atrial mass and stenosis of a severely calcified aortic valve, but no definite vegetations. The diagnose of infectious endocarditis was established during surgery, with the discovery of an abscess cavity at the non-coronary cusp of the aortic valve and by the growth of the same CoNS from tissue samples from the abscess in the atrial wall, as had been found in blood cultures. A systolic murmur was heard initially, but echocardiography was not performed until 5 weeks later and illustrates the pivotal role of echocardiography in the early diagnosis and treatment of infectious endocarditis.