Case Report of Abiotrophia Defectiva Endocarditis: Treatment of Severe Mitral Regurgitation and Anemia in a Jehovah’s Witness Patient

Background: We report a case of a 50-year-old Jehova´s Witness male with Abiotrophia defectiva endocarditis on the mitral valve (MV) with severe mitral regurgitation (MR), multiple septic emboli and accompanying anemia. Due to his religious beliefs, he strictly refused blood transfusion. The aim of this case is to show that with an individual preoperative management a surgical valve replacement without blood transfusion is feasible. Case Summary: Our patient presented with a 6-month history of B-symptoms, abdominal pain and shortness of breath. In clinical examination cardiac murmur was found, ultrasound showed splenomegaly with suspicion of segmental splenic infarct which was confirmed by magnetic resonance imaging (MRI). A severe MR with multiple vegetation's was found by transthoracic echocardiogram (TTE) and trans-oesophageal echocardiogram (TEE). Multiple blood culture samples detected the streptococcus Abiotrophia defectiva. First, a calculated antibiotic treatment was initiated and as the patient refused blood transfusion, an additional iron treatment as well as recombinant human erythropoietin substitution were performed to address the anemia. Finally, the patient underwent open cardiac surgery with biological valve replacement using autologous transfusion. Following surgery, he showed regular function of the MV-prothesis by TTE up to 24 months postoperative. Discussion: Infective endocarditis (IE) is mostly caused by common pathogens like staphylococcus aureus, streptococcus viridans and enterococcus faecalis. Nevertheless, multiple rare pathogens are described to provoke IE. In our case the streptococcus Abiotrophia defectiva, belonging to the natural environment of the oral cavity, the gastrointestinal and urogenital tract, was found. Due to its slow growing rate, its identification is challenging. As our patient refused blood transfusion and early surgical valve replacement, but showed hemodynamic stability we could develop this individual therapeutic management with intravenous antibiotics as well as iron and erythropoietin substitution to achieve operability.