Prosthetic valve endocarditis presenting as meningoencephalitis complicated by pseudo-Aneurysms in a remote Aboriginal healthcare setting in Australia: A case report

Background: The Australian Aboriginal population has a high burden of cardiac conditions predisposing patients to infective endocarditis. Pseudo-Aneurysms are a rare and potentially fatal complication of both prior valvular surgery and endocarditis. 

Case summary: A 31-year-old female with a history of bicuspid aortic valve requiring valve replacement presented with meningoencephalitis. Transoesophageal echo and positive blood cultures for Staphylococcus aureus confirmed prosthetic valve endocarditis (PVE). Aortic root mycotic pseudo-Aneurysms developed during antimicrobial therapy and two large pseudo-Aneurysms remain post-redo valve, root and arch replacement. 

Discussion: Complications associated with PVE are common, especially due to S. aureus. Redo cardiac surgery is high risk, percutaneous treatments may be technically difficult due to altered post-operative anatomy, and medication adherence issues and lack of healthcare engagement further compromise optimal care in this patient population.