Streptococcus gallolyticus-induced “kissing abscess” of anterior mitral valve leaflet and intervalvular fibrosa from an aortic valve endocarditis – a case of delayed diagnosis

Andreea-Mihaela Ignat, Andreea-Maria Ursaru, Dana Corduneanu, Irina Iuliana Costache, Marilena Spiridon, Antoniu Octavian Petris, Alexandru Titu Ciucu, Dan-Nicolae Tesloianu


A fatal disease until Mid-Twentieth Century, nowadays infective endocarditis is curable due to advances in diagnostic techniques, especially in echocardiography, the possibility of cardiac surgery during the active infectious process and new antibiotics. We present a 62 years-old man, with no significant past medical illness, referred for persistent cough, fatigue, shortness of breath, loss of weight and paleness, with recent history of persistent fever and positive blood cultures with Streptococcus gallolyticus. Echocardiographic examination revealed aortic and mitral valve vegetations and anterior mitral valve leaflet abscess. During surgery, the presence of a “kissing abscess” on the atrial side of the anterior mitral leaflet, arising from a vegetation on the non-coronary cusp of the aortic valve, was confirmed, together with an intervalvular fibrosa abscess. Special reinforcement with an oversewn bovine pericardial patch and reconstruction of the intervalvular fibrous body was necessary during aortic and mitral valve replacement. Despite delayed diagnosis, the case had a favorable outcome, the patient being discharged presenting a good clinical state. Numerous complications, including abscesses and early infective endocarditis on prosthetic aortic valve, would have been probably avoided with prompt recognition and early treatment of endocarditis.


delayed diagnosis, infective endocarditis, “kissing abscess”, Streptococcus gallolyticus, acute kidney injury

Full Text:



Murdoch DR, Corey GR, Hoen B, et al. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis‐Prospective Cohort Study. Arch Intern Med 2009; 169:463–473.

Fazlinezhad A, Mirzaeei A, Alvandi Azari M. Ruptured mitral valve kissing abscess to left atrium in course of aortic valve endocarditis. Shiraz E Med J 2011; 30:112-117.

Gülşen K, Duygu H, Cerit L. A new entity in an immunosuppressive patient: Giant reverse kissing vegetation. Int J Cardiol 2015; 201:279–281.

Fazlinezhad A, Fatehi H, Tabaee S, et al. Pseudoaneurysm of mitro-aortic intervalvular fibrosa during the course of mitral valve endocarditis with aorto-left ventricle outflow tract fistula. J Saudi Heart Assoc 2012; 24(3):201-204.

Cecchi E, Forno D, Imazio M, et al. New trends in the epidemiological and clinical features of infective endocarditis: results of a multicenter prospective study. Ital Heart J 2004; 5(4):249-56.

Flegel KM. Does the physical examination have a future? Can Med Assoc J 1999; 161 (9):1117–1118.

Larry MB, William KF, Rakesh MS, et al. Braunwald’s Heart Disease a textbook of cardiovascular disease. 10th ed. Philadelphia: Elsevier Saunders; 2015: 1524-1543.

Laurence HC, Piper C, Hetzer R, et al. Textbook of cardiac surgery in adults. 3rd Edition. Boston: McGraw-Hill; 2008.

Lee CC, Siegel RJ. Sinus of valsalva pseudoaneurysm as a sequela to infective endocarditis. Tex Heart Inst J 2016; 43(1):46–48.

Easaw J, El-Omar M, Ramsey M. "Kissing abscess" of the anterior mitral valve leaflet from a vegetation on the non-coronary aortic cusp. Heart 2001; 86(1): 90.

Corredoira J, Alonso MP, Coira A, et al. Characteristics of Streptococcus bovis endocarditis and its differences with Streptococcus viridans endocarditis. Eur J Clin Microbiol Infect Dis 2008; 27:285-291.

Abdulamir AS, Hafidh RR, Abu Bakar F. The association of Streptococcus bovis/gallolyticus with colorectal tumors: the nature and the underlying mechanisms of its etiological role. J Exp Clin Cancer Res 2011; 30:11.

Klein RS, Recco RA, Catalano MT, et al. Association of Streptococcus bovis with carcinoma of the colon. N Engl J Med 1977; 297:800-2.

Abeni C, Rota L, Ogliosi C, et al. Correlation among Streptococcus bovis, endocarditis and septicemia in a patient with advanced colon cancer: a case report. J Med Case Rep 2013; 7:185.

Boleij A, Muytjens CMJ, Bukhari SI, et al. Novel clues on the specific association of Streptococcus gallolyticus subsp gallolyticus with colorectal cancer. J Infect Dis 2011; 203(8):1101-1109.

Ferrari A, Botrugno I, Bombelli E, et al. Colonoscopy is mandatory after Streptococcus bovis endocarditis: a lesson still not learned. World J Surg Oncol 2008; 6:49.

Chu VH, Cabell CH, Benjamin DK Jr, et al. Early predictors of in-hospital death in infective endocarditis. Circulation 2004; 109(14):1745-9.

Akowuah EF, Davies W, Oliver S, et al. Prosthetic valve endocarditis: early and late outcome following medical or surgical treatment. Heart 2003; 89(3):269–272.


Copyright (c) 2016 Andreea-Mihaela Ignat, Andreea-Maria Ursaru, Dana Corduneanu, Irina Iuliana Costache, Marilena Spiridon, Antoniu Octavian Petris, Alexandru Titu Ciucu, Dan-Nicolae Tesloianu

Creative Commons License
Archive of Clinical Cases is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.


ISSN: 2360-6975