ABSTRACT

We report a case of 16-year-old Thai male with nontoxigenic Corynebacterium diphtheriaeendocarditis with cardiogenic shock and severe congestive heart failure.  The patient presented with a high-grade fever for 3 days and shortness of breath 1 day prior to this admission.  At the emergency room, he was diagnosed with severe community acquired pneumonia with septic shock.  The fluid resuscitation was delivered with isotonic saline and the patient was initiated promptly with intravenous antibiotics including ceftriaxone, cloxacillin and azithromycin.  However, his condition worsened and he developed respiratory failure necessitating intubation with pink frothy sputum observed.  At the intensive care unit, a careful physical examination revealed tachycardia without heart murmur and fine crackles in both lungs.  Transthoracic echocardiography noted a mobile mass at the mitral valve leaflet and severe mitral valve regurgitation.  An emergency thoracotomy was performed for mitral valve replacement.  The intraoperative findings demonstrated flail anterior mitral valve leaflet with multiple nodules compatible with infective endocarditis.  Blood and tissue cultures grew nontoxigenic Corynebacterium diphtheriae.  The antibiotic regimen was then adjusted to 24 million units of penicillin G sodium per day as a definitive treatment and he was discharged home in a good condition after an 8-week course of therapy.  (J Infect Dis Antimicrob Agents 2015;32: 135-9.)