Infective endocarditis (IE) in pregnancy is an extremely rare disease associated with high maternal and fetal mortality. In the presence of intravenous drug abuse (IDU), prosthetic valve, congenital heart disease and rheumatic heart disease patients are known to have higher risk for IE. Patients with IE may present with fever, chills, poor appetite, weigh loss.
We report a 32-year-old woman who was admitted to hospital with fever and altered consciousness. She was on her 24 + 4/7 gestational week; she had a history of preeclampsia and a previous cesarean section. Her brain MRI showed signs of ischemic stroke. Her blood culture was tested positive for staphylococcus aureus and as her medical condition deteriorated, further investigation revealed that she had been an intravenous drug user and transesophageal echocardiography displayed vegetations on the mitral and aortic valves that confirmed IE. Multidisciplinary team decided to offer interruption of pregnancy, after meticulous counseling, at 25 +0/7 gestational week an emergency cesarean section (C/S) was performed. Two weeks after the delivery, mechanical aortic (AVR) and mitral valve replacements (MVR) were performed. Fifteen months after AVR and MVR, she had a myocardial infarction (MI); 5 months later she died due to congestive heart failure.
A high index of suspicion is required to diagnose IE since this serious disease may present with different clinical manifestations in pregnancy. Multidisciplinary approach is mandatory as soon as the diagnosis is established. Despite proper management it has a dismal prognosis, both in the short and long term.
Anahtar Kelimeler: Pregnancy, Infective Endocarditis, Intravenous Drug Use
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