Tricuspid valve endocarditis caused by Campylobacter fetus bacteraemia in a 48-year old female: a case report

Campylobacter infections are very common overall. They typically affect the gastrointestinal tract and are usually caused by consumption of contaminated meat or water. Older people, men, and people with weakened immune systems are significantly more likely to be affected. Endocarditis caused by Campylobacter fetus, especially of the tricuspid valve, is rarely reported and not easy to diagnose.

A 48-year-old female patient presented to the emergency department with pain in the upper abdomen and left flank and tenderness in the left chest. After initially ruling out pyelonephritis, within the scope of focus search, vegetation on the tricuspid valve with rapidly progressive tricuspid valve insufficiency was observed. Campylobacter fetus grew in the initial blood cultures. Antibiotic treatment was initiated with ceftriaxone. Due to additional unclear renal insufficiency and further treatment, the patient was transferred to an interdisciplinary centre, where tricuspid valve replacement was performed. The patient was discharged home with a peripherally inserted central catheter for prolonged intravenous antibiotic therapy with meropenem.

Diagnosis was difficult based on the variety of symptoms, as the patient was a younger female who did not present with typical symptoms of endocarditis. Follow-up examinations and consultation with an interdisciplinary centre were necessary to ensure adequate treatment. The patient initially received intravenous cephalosporin, aminopenicillin, and finally carbapenem antibiotics. Due to a lack of recommendations, antibiotic therapy was based on empirical evidence. Amoxicillin–clavulanic acid and imipenem have been described as effective antibiotics against almost all strains of C. fetus.