Document Type

Conference Proceeding

Publication Date

5-1-2026

Abstract

Background: A 66-year-old male with MRSA bacteremia developed septic pulmonary emboli, sternoclavicular joint infection, and prosthetic knee infection. While initial TTE was negative, subsequent TEE identified a large supravalvular aortic vegetation necessitating surgical excision and valve repair, underscoring the diagnostic superiority of TEE and the need for early surgical consideration in complicated MRSA endocarditis. Case Presentation: A 66-year-old male with diabetes, hypertension, and prior knee arthroplasty presented with MRSA bacteremia complicated by septic pulmonary emboli, sternoclavicular joint infection, and prosthetic knee infection. He underwent debridement of the chest wall and knee prosthesis with cultures confirming MRSA. Initial transthoracic echocardiography (TTE) was negative, but transesophageal echocardiography (TEE) revealed a large supravalvular aortic vegetation with mild regurgitation. Because of the large vegetation, the cardiothoracic surgery team was involved, and the patient underwent aortic valve repair with excision of the mass, which was 6 cm long, and bovine pericardial patch reconstruction. Pathology confirmed MRSA endocarditis, and he completed a 6-week course of intravenous daptomycin with uneventful recovery. Discussion: This case illustrates the importance of multidisciplinary team involvement to act upon the findings and decide the best approach to treat the source as well as the complications of infective endocarditis. It spots a light on the importance of getting an echocardiography, TEE to be specific, in patients with bacteremia with high-risk organisms such as MRSA. Starting with TTE is acceptable, however TEE is warranted if clinical suspicion is high. Rapid escalation of care is essential in patient with complications like septic emboli as well as large vegetations that needs surgical intervention. With our case, the patient had 6 cm vegetation which is considered significantly large that the need of surgical intervention was necessary. Conclusion: Early use of TEE and prompt multidisciplinary intervention are essential for timely surgical management and improved outcomes in patients with complicated MRSA endocarditis

Comments

American College of Physicians Michigan Chapter and Society of Hospital Medicine Michigan Chapter 2026 Resident and Medical Student Day, May 1, 2026, Troy, MI

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