A fatal case of diphtheria endocarditis complicated with microangiopathic haemolytic anaemia and multiple septic emboli causing brain infarctions in a patient with smear-positive pulmonary tuberculosis

Abstract

ndocarditis due to non-toxigenic Corynebacterium diphtheriae is emerging as a rare subtype of endocarditis, with limited case reports available. It has been related to the presence of prosthetic valves, underlying cardiac disease, or the use of injectable drugs. We present a fatal case of endocarditis due to non-toxigenic Corynebacterium diphtheriae in a native aortic valve complicated with microangiopathic haemolytic anaemia and multiple septic emboli in the brain causing infarctions in a patient with smear-positive pulmonary tuberculosis who was on anti-tuberculosis therapy (ATT). Following blood culture positivity and suggestive evidence from the echocardiogram, the patient was initially treated with intravenous ceftriaxone and vancomycin along with ATT. Evolution was assessed by sterile blood cultures post therapy and follow-up transthoracic echocardiograms (TTE) and transesophageal echocardiograms (TOE). Even though the patient's condition improved with intravenous antibiotic therapy, it later deteriorated with disseminated intravascular coagulation and liver injury followed by prerenal acute kidney injury and multiple septic emboli causing the patient’s demise, which may have necessitated surgical interventions.

Keywords

• Corynebacterium diphtheriae
• Infective endocarditis
• Septic emboli
• Pulmonary tuberculosis
• Microangiopathic hemolytic anemia
• Disseminated intravascular coagulation