Pseudomonas Endocarditis of the Mitral Valve in an Intravenous Drug User: an Unusual Presentation, Organism, and Treatment

Infective endocarditis (IE) is a serious infection of the endocardium of the heart, particularly the valves. It represents the fourth leading cause of life-threatening infectious disease syndromes and does carry poor prognosis. Common causative bacteria for IE are gram-positive microorganisms compared to gram-negative bacteria such as Pseudomonas aeruginosa. Pseudomonas endocarditis is an aggressive infection with unfavorable outcomes. Patients with right-sided infection typically have milder course of the disease and better prognosis compared to those with left-sided valve involvement. Surgical valve replacement in addition to prolonged course of antibiotics appears to be the treatment approach of choice to most cases of left-sided Pseudomonas IE. Left-sided IE caused by Pseudomonas in a drug abuser is rare. A 65-year-old male presented with fever and symptoms of acute heart failure and complete heart block. He was diagnosed with mitral valve infective endocarditis on basis of echocardiography and blood culture results and did not undergo surgical mitral valve replacement due to his preference. He responded well to treatment with antibiotics and discharged home in good condition. In this case, we report an unusual presentation and site of infection for Pseudomonas in a drug abuser which was successfully treated with antibiotics and without surgery.