Virginia Research Day 2025

Medical Student Research Case Reports

16 Infective Endocarditis in a 19-Year-Old Basketball Player

Neal Patel, OMS-II; Max Farenwald, DO; Kristina Werner, MD Corresponding author: npatel09@vcom.edu

Virginia Tech Carillion Clinic Edward Via College of Osteopathic Medicine

glenohumeral joint effusion concerning for septic arthritis. Orthopedics was consulted to perform a left glenohumeral joint aspiration. Overnight, patient developed a fever of 100.8F, and his blood culture returned positive for Strep Agalactiae. Echo revealed severe aortic regurgitation with a dilated left ventricle in the setting of Group B strep bacteremia. Joint aspiration fluid confirmed Strep Agalactiae. Surgical debridement was performed without complication. On hospital day three patient reported new onset chest pain. Repeat EKG showed ST depression in multiple leads and his hsTroponin increased to 2,803. Repeat echo showed new mitral valve regurgitation and tricuspid regurgitation. Cardiology was notified and performed an emergent mitral valve repair with aortic valve replacement. Due to post-operative atrial tachyarrhythmia, a dual chamber pacemaker was implanted. Post-operative

right and left ventricle function was optimal and consistent with pacing via pacemaker. It was proposed that the atrial tachyarrhythmia would resolve with time as his bodily inflammation improved. Prior to discharge, the patient’s vitals stabilized and his repeat blood cultures remained negative. He was set up for outpatient management with cardiology, infectious disease, and orthopedics. This presents a rare case of multivalve infectious endocarditis with a unique infecting pathogen. 80% of the infecting pathogens is Staph. Aureus. However, in this patient, the infecting agent was Strep. Agalactiae, a Group B Streptococcal agent. Typically, the populations most at risk from Strep. Agalactiae infection are newborns and pregnant women, however, in this case, it is a 19-year-old male with no predisposing conditions.

A 19-year-old basketball player presented to the ED with complaints of fevers, abdominal pain, thoracic back pain, and fatigue. On physical exam, patient had normal cardiac and respiratory findings with mild tenderness in the RUQ. Left shoulder was tender to palpation, but had full range of motion and normal strength. Patient had tenderness at the 2 nd intercostal space on the left lateral border of the sternum and a grouped somatic dysfunction at the level of T2-T4. Additionally, osteopathic sacral exam showed a right on-right sacral torsion. The patient was admitted to the hospital for further workup and close monitoring. His vitals were stable on room air. Initial labs showed leukocytosis-14.3 elevated CRP-17, hsTroponin-305, but were otherwise normal. EKG was NSR with rate of 80bpm. RUQ Ultrasound was completed with no abnormalities noted. Left shoulder XR was completed and identified a cortical irregularity along the clavicular margin. Shoulder MRI revealed a left

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