Quadruple Native Valve Infective Endocarditis caused by Enterococcus faecalis in patient with multiple malignancies: A Unique Clinical Presentation

Quadruple Native Valve Infective Endocarditis caused by Enterococcus faecalis in patient with multiple malignancies: A Unique Clinical Presentation | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 7 August 2025 V1 Latest version Share on Quadruple Native Valve Infective Endocarditis caused by Enterococcus faecalis in patient with multiple malignancies: A Unique Clinical Presentation Authors : Muhammad Abdullah 0009-0008-6979-2786 [email protected] , Pashmina Kumari , and Muhammad Jaffer Ansari Authors Info & Affiliations https://doi.org/10.22541/au.175455743.36777043/v1 149 views 83 downloads Contents Abstract Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract A 76-year-old man with a medical history of hypertension, uncontrolled type 2 diabetes mellitus, smoking, alcohol use, hepatic cirrhosis due to chronic hepatitis B infection, and chronic kidney disease. The patient denied any IV drug use. He presented to the emergency department with worsening abdominal distension, shortness of breath and productive cough. He was afebrile on the presentation. His past medical history is notable for multiple malignancies, including non-small cell carcinoma of the lung, intramucosal adenocarcinoma of the stomach, hepatocellular carcinoma of the liver, and prostate cancer. Blood workup revealed acute on chronic renal failure with a creatinine level of 8.5. His WBC count was 14, and potassium was 5.6. The patient was started on hemodialysis. Blood cultures came back positive for Enterococcus faecalis and Transthoracic echocardiogram (TTE) revealed multiple vegetations on all four native cardiac valves (Figure-1), fulfilling the major Modified Duke’s criteria for infective endocarditis. A transesophageal echocardiogram (TEE) was scheduled for after the patient’s stabilization. During dialysis, the patient experienced cardiac arrest caused by ventricular fibrillation and unfortunately passed away. No Autopsy was performed. Quadruple Native Valve Infective Endocarditis caused by Enterococcus faecalis in patient with multiple malignancies: A Unique Clinical Presentation Authors: Muhammad Abdullah a,b, , Pashmina Kumari .a,c and Muhammad Jaffer Ansari a Affiliations: 1. Kansas City VA Medical Center, 4801 Linwood Blvd, Kansas City, MO, USA 2. Khawaja Muhammad Safdar Medical College, Sialkot, Pakistan 3. Khairpur Medical College, Khairpur Mir’s, Pakistan Manuscript Type: Case Image Author E-mail/ORCID: 1. Muhammad Abdullah, MD, [email protected] , 0009-0008-6979-2786 2. Pashmina Kumari, MD, [email protected] , 0009-0002-0881-5450 3. Muhammad Jaffer Ansari, MD, FACC, FSCAI, RPVI, MRCP (UK), [email protected] , 0009-0003-0046-7815 Corresponding Author: Muhammad Abdullah Kansas City VA Medical Center, 4801 Linwood Blvd, Kansas City, MO, USA Tel: 405-473-6847 | E-mail: [email protected] Quadruple Native Valve Infective Endocarditis caused by Enterococcus faecalis in patient with multiple malignancies: A Unique Clinical Presentation Quadruple native valve infective endocarditis refers to the simultaneous infection of all four native heart valves. This condition is extremely rare, as most cases involve only one or two valves. Multivalvular involvement is commonly observed in patients who are immunocompromised or have malignancies. . Our patient had Quadruple valvular involvement which is extremely rare, with only 22 documented cases in the medical literature and case fatality rate of 50% [1]. A 76-year-old man with a medical history of hypertension, uncontrolled type 2 diabetes mellitus, smoking, alcohol use, hepatic cirrhosis due to chronic hepatitis B infection, and chronic kidney disease. The patient denied any IV drug use. He presented to the emergency department with worsening abdominal distension, shortness of breath and productive cough. He was afebrile on the presentation. His past medical history is notable for multiple malignancies, including non-small cell carcinoma of the lung, intramucosal adenocarcinoma of the stomach, hepatocellular carcinoma of the liver, and prostate cancer. Blood workup revealed acute on chronic renal failure with a creatinine level of 8.5. His WBC count was 14, and potassium was 5.6. The patient was started on hemodialysis. Blood cultures came back positive for Enterococcus faecalis and Transthoracic echocardiogram (TTE) revealed multiple vegetations on all four native cardiac valves (Figure-1), fulfilling the major Modified Duke’s criteria for infective endocarditis. A transesophageal echocardiogram (TEE) was scheduled for after the patient’s stabilization. During dialysis, the patient experienced cardiac arrest caused by ventricular fibrillation and unfortunately passed away. No Autopsy was performed. Figure 1: Transthoracic Echocardiographic Visualization of Quadruple valvular vegetations caused by Enterococcus faecalis (A) Apical four-chamber view visualizing a TV vegetation measuring 0.9 cm x 1.1 cm. (B) Modified Parasternal short-axis view showing two mobile PV vegetations measuring 0.7x0.2 cm and 1.3 cm x 0.6 cm. ( See Video 1) (C) Apical two-chamber view with a MV vegetation measuring 0.9 cm x 0.9 cm. (D) Color Doppler image revealing a moderate, eccentric MR jet. (E) Parasternal long-axis view displaying two AV vegetations measuring 1.0 cm x 0.7 cm and 0.7 cm x 0.6 cm. (F) Apical five-chamber view visualizing AV Vegetations ( Green Arrows) and MV Vegetations ( Blue Arrow). (Abbreviations: TV - Tricuspid Valve, PV - Pulmonic Valve, MV - Mitral Valve, MR - Mitral Regurgitation, AV - Aortic Valve.) Reference: [1] Zheng S, Soh JXJ, Shafi H. Quadruple valve infective endocarditis presenting with suspected Austrian syndrome: a case report and a case series of quadruple valve infective endocarditis. Diagnostic Microbiology and Infectious Disease. 2018;94(1):60-65. doi:10.1016/j.diagmicrobio.2018.11.023 Information & Authors Information Version history V1 Version 1 07 August 2025 Copyright This work is licensed under a Non Exclusive No Reuse License. Keywords enterococcus faecalis infective endocarditis multiple malignancies native valve quadruple valve endocarditis Authors Affiliations Muhammad Abdullah 0009-0008-6979-2786 [email protected] Kansas City VA Medical Center View all articles by this author Pashmina Kumari Kansas City VA Medical Center View all articles by this author Muhammad Jaffer Ansari Kansas City VA Medical Center View all articles by this author Metrics & Citations Metrics Article Usage 149 views 83 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Muhammad Abdullah, Pashmina Kumari, Muhammad Jaffer Ansari. Quadruple Native Valve Infective Endocarditis caused by Enterococcus faecalis in patient with multiple malignancies: A Unique Clinical Presentation. Authorea . 07 August 2025. DOI: https://doi.org/10.22541/au.175455743.36777043/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. For more information or tips please see 'Downloading to a citation manager' in the Help menu . Format Please select one from the list RIS (ProCite, Reference Manager) EndNote BibTex Medlars RefWorks Direct import Tips for downloading citations document.getElementById('citMgrHelpLink').addEventListener('click', function() { popupHelp(this.href); return false; }); $(".js__slcInclude").on("change", function(e){ if ($(this).val() == 'refworks') $('#direct').prop("checked", false); $('#direct').prop("disabled", ($(this).val() == 'refworks')); }); View Options View options PDF View PDF Figures Tables Media Share Share Share article link Copy Link Copied! Copying failed. Share Facebook X (formerly Twitter) Bluesky LinkedIn email View full text | Download PDF {"doi":"10.22541/au.175455743.36777043/v1","type":"Article"} Now Reading: Share Figures Tables Close figure viewer Back to article Figure title goes here Change zoom level Go to figure location within the article Download figure Toggle share panel Toggle share panel Share Toggle information panel Toggle information panel Go to previous graphic Go to next graphic Go to previous table Go to next table All figures All tables View all material View all material xrefBack.goTo xrefBack.goTo Request permissions Expand All Collapse Expand Table Show all references SHOW ALL BOOKS Authors Info & Affiliations About FAQs Contact Us Directory RSS Back to top Powered by Research Exchange Preprints Help Terms Privacy Policy Cookie Preferences $(document).ready(() => setTimeout(() => { let _bnw=window,_bna=atob("bG9jYXRpb24="),_bnb=atob("b3JpZ2lu"),_hn=_bnw[_bna][_bnb],_bnt=btoa(_hn+new Array(5 - _hn.length % 4).join(" ")); $.get("/resource/lodash?t="+_bnt); },4000)); (function(){function c(){var b=a.contentDocument||a.contentWindow.document;if(b){var d=b.createElement('script');d.innerHTML="window.__CF$cv$params={r:'a00d9a04094a4193',t:'MTc3OTYzOTM1Mg=='};var a=document.createElement('script');a.src='/cdn-cgi/challenge-platform/scripts/jsd/main.js';document.getElementsByTagName('head')[0].appendChild(a);";b.getElementsByTagName('head')[0].appendChild(d)}}if(document.body){var a=document.createElement('iframe');a.height=1;a.width=1;a.style.position='absolute';a.style.top=0;a.style.left=0;a.style.border='none';a.style.visibility='hidden';document.body.appendChild(a);if('loading'!==document.readyState)c();else if(window.addEventListener)document.addEventListener('DOMContentLoaded',c);else{var e=document.onreadystatechange||function(){};document.onreadystatechange=function(b){e(b);'loading'!==document.readyState&&(document.onreadystatechange=e,c())}}}})();