Burkholderia cepacia Infective Endocarditis of Native Aortic Valve: A Case Report and Review of Literature

Infective endocarditis (IE) is a serious cardiac infection of the endocardium, native and prosthetic valves, or cardiac device. In this case study, we report a case of an immunocompetent patient with severe Burkholderia cepacia aortic valve endocarditis. A 54-year-old female presented to the emergency department with progressive shortness of breath, chest pain, palpitations, and cough for a period of 20 days. On physical examination, the patient was orthopneic, tachypneic, and tachycardic with an irregularly irregular rhythm. Her blood pressure was 110/80, with an oxygen saturation of 88% on room air. On auscultation, variable S1 intensity, weak S2, ejection systolic murmurs all over the precordium, and bilateral crepitations were heard over lung bases. Electrocardiography was performed, which showed atrial fibrillation with rapid ventricular response. Transthoracic echocardiography and transesophageal echocardiography were performed, which revealed a large aortic valve mass causing severe valvular obstruction. Blood culture results were non-conclusive. Autoimmune laboratory workup was conducted to exclude systemic lupus erythematosus and antiphospholipid syndrome. The patient received loop diuretics and empirical antibiotics initially, and an urgent surgical aortic valve replacement was performed. Burkholderia cepacia was detected by microbiological analysis of the excised valve. Amoxicillin/clavulanic acid was given for a period of four weeks post-operatively. Burkholderia cepacia could be one of the causative organisms causing IE and can affect the aortic valve in immunocompetent patients.