CONCOMITANT INFECTIVE ENDOCARDITIS AND DENGUE SHOCK SYNDROME: A CASE REPORT OF ESCHERICHIA COLI INFECTION

Abstract

Infective endocarditis caused by the Gram-negative bacterium Escherichia coli is rare. Concomitant dengue virus infection can exacerbate the immune response and increase the risk of mortality. In this case report, a 34-year-old male with suspected posterior mitral valve vegetation (PML) and moderate-to-severe mitral regurgitation (ejection fraction of 53% and a tricuspid annular plane systolic excursion [TAPSE] of 23%) according to echocardiography, complains of shortness of breath and a seven-day fever (temperature of 38.5°C). He also exhibits clinical signs of shock and intestinal bleeding. A complete blood count revealed thrombocytopenia and hypoalbuminemia, and a blood culture showed growth of Escherichia coli. The patient received definitive antibiotic therapy based on sensitivity testing (ceftriaxone and gentamicin) for seven days, along with supportive therapy (fluid resuscitation, vasopressors, platelet transfusion, and albumin). The Everest score was used to measure congestion levels until the patient passed through the critical phase. The initial score was 8, and the discharge score was 0. Comprehensive management is required for infective endocarditis caused by Escherichia coli in patients with dengue virus infection. Administering rational antibiotics, fluid therapy, and inotropic support in accordance with sepsis management protocols improves clinical outcomes.