Acne on the Valve: A Case of Cutibacterium Acnes Prosthetic Valve Endocarditis and Aortic Root Abscess

Document Type

Conference Proceeding

Publication Date

4-7-2026

Publication Title

Journal of the American College of Cardiology

Abstract

BACKGROUND Although Cutibacterium acnes is a rare cause of infective endocarditis, patients with prosthetic valves or implanted devices are at increased risk. Its diagnosis is often challenging and may be overlooked, particularly in culture-negative cases. CASE A 62-year-old man with a history of bicuspid aortic valve status post Bentall procedure, presented with one week of fevers. Work up revealed leukocytosis of 25.4 x109/L, CRP of 253.4 mg/L, and up trending high sensitivity troponin I to 1488 ng/dL. ECG showed a new first-degree AV block. Transthoracic echocardiogram identified a 13×12 mm echogenic mass on the aortic valve with a mean gradient of 34 mmHg. Transesophageal echocardiography confirmed an aortic valve vegetation with evidence of a root abscess (Figure 1). Blood cultures grew Cutibacterium acnes on day 7, prompting targeted therapy with daptomycin, cefepime, and doxycycline. The patient underwent a successful redo-Bentall procedure and was discharged with a six-week antibiotic regimen. DECISION-MAKING This case illustrates that C. acnes, though rare, can cause infective endocarditis involving prosthetic valves and vascular grafts. It underscores the importance of maintaining a high index of suspicion for atypical pathogens and the need for prolonged blood culture incubation to enable accurate identification. CONCLUSION Failure to recognize the causative organism and initiate appropriate targeted therapy may result in inadequate treatment and catastrophic complications.

Volume

87

Issue

13 Suppl

First Page

A1891

Comments

American College of Cardiology 75th Annual Scientific Session & Expo, March 28-30, 2026, New Orleans, LA

Last Page

A1892

DOI

10.1016/j.jacc.2026.02.4711

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