STREPTOCOCCUS-SALIVARIUS ENDOCARDITIS IN A PATIENT WITH OBSTRUCTIVE HYPERTROPHIC CARDIOMYOPATHY - REPORT OF A CASE - REVIEW OF THE LITERATURE

A case of Streptococcus salivarius endocarditis in a patient with obst ructive hypertrophic cardiomyopathy (OHCM) is reported. Vegetations de veloped on the antero-left aortic leaflet and on the anterior mitral l eaflet, The portal of entry was probably a dental infection. Despite a n episode of splenic embolization, the course was favorable under anti microbial therapy alone. A review of the literature showed that infect ive endocarditis is uncommon in patients with OHCM, Most patients were young. Although the organism was a usually pathogenic Streptococcus i n most instances, some cases were due to opportunistic organisms. No c orrelations were found with the gradient in the left ventricular chamb er, wall thickness, or presence of mitral regurgitation. Asymmetric hy pertrophy was identified as a risk factor. The most common pattern of valve damage was involvement of the anterior mitral leaflet, followed by concomitant involvement of the mitral and aortic valves. Severe out comes were common, especially in patients with involvement of the mitr al and aortic valves. The value of scrupulously performed antimicrobia l prophylaxis in patients with OHCM is emphasized. It is also essentia l to establish the diagnosis early by performing microbiological studi es, transthoracic echocardiography, and, above al, transesophageal ech ocardiography.