Journal of Advanced Intensive and Critical Care Medicine

Abstract

Abstract: Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiac disorder, affecting approximately 1 in 500 individuals. Infective endocarditis (IE) is an uncommon but potentially fatal complication in patients affected by hypertrophic cardiomyopathy (HCM). The risk has been described to be significantly higher than in the general population, but the incidence of IE in HCM population remains unknown. The complex pathophysiology of this disease, characterized by structural alterations of the mitral valve apparatus and the presence of turbulent flow that promotes the deposition of microorganisms, could provide a substrate for IE and may, to some extent, explain its higher incidence in this specific population. We report the case of a 54-year-old man with known HCM who presented with progressive dyspnea, irregular fever and weight loss for 3 months. Transesophageal echocardiography demonstrated a mobile vegetation measuring 11 × 4.7 mm attached to the mitral valve, with preserved left ventricular ejection fraction. As patient got multiple antibiotics prior admission, blood culture failed to reveal growth of any organism. He was diagnosed as a case of infective endocarditis on the basis of modifies Duke’s criteria. The patient was managed with intravenous antibiotic therapy. This case highlights the uncommon occurrence of IE in patients with HCM and underscores the pivotal role of transesophageal echocardiography in establishing the diagnosis. Our observation adds to the limited number of published cases and emphasizes the importance of early recognition and multidisciplinary evaluation in this challenging clinical scenario.