A 76-year-old man with a medical history of hypertension, uncontrolled type 2 diabetes mellitus, smoking, alcohol use, hepatic cirrhosis due to chronic hepatitis B infection, and chronic kidney disease. The patient denied any IV drug use. He presented to the emergency department with worsening abdominal distension, shortness of breath and productive cough. He was afebrile on the presentation. His past medical history is notable for multiple malignancies, including non-small cell carcinoma of the lung, intramucosal adenocarcinoma of the stomach, hepatocellular carcinoma of the liver, and prostate cancer. Blood workup revealed acute on chronic renal failure with a creatinine level of 8.5. His WBC count was 14, and potassium was 5.6. The patient was started on hemodialysis. Blood cultures came back positive for Enterococcus faecalis and Transthoracic echocardiogram (TTE) revealed multiple vegetations on all four native cardiac valves (Figure-1), fulfilling the major Modified Duke's criteria for infective endocarditis. A transesophageal echocardiogram (TEE) was scheduled for after the patient's stabilization. During dialysis, the patient experienced cardiac arrest caused by ventricular fibrillation and unfortunately passed away. No Autopsy was performed.
Abdullah et al. (Thu,) studied this question.