Page 58 - JSOM Winter 2025

Infective Endocarditis

Severe Complication from a Common Procedure

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2
Garrett A. Maurice, FP-C ; Christopher S. Freeman, FP-C ;
Adam M. Spanier, MD ; Joseph W. Jude, MD *
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4

ABSTRACT
We describe an Army Officer with infectious endocarditis af- had redness and irritation in his antecubital fossa, shown in
ter being hospitalized with a heat injury while participating in Figure 1, where he had an IV placed in the field, and it was
Special Forces Assessment and Selection. A 26-year-old other- not removed until he was discharged from the civilian hospital
wise healthy male presented with a fever, skin lesions, and pain 3 days after injury. During the physical exam, the physician
at his IV site after a recent hospitalization. He was admitted noted tender lesions on the plantar surface of both feet (Fig-
on intravenous antibiotics due to suspicion of bacteremia and ure 2) and a tender erythematous nodule in the left antecubi-
was eventually diagnosed with MRSA endocarditis. The pa- tal fossa. No murmur was heard. The patient was admitted
tient required months of antibiotics and left brachial vein exci- and placed on vancomycin and piperacillin/tazobactam due to
sion for source control. After multiple readmissions for MRSA concerns for bacteremia and possible endocarditis.
bacteremia over the following 2 years, the patient was placed
on daily prophylactic doxycycline. Due to complications from
his condition, the patient was medically retired from the Army.
When the tactical setting allows, prehospital providers must
practice aseptic techniques and advocate for their patients
when other providers lack awareness of the impact of field
environments.
FIGURE 1 Patient’s left
Keywords: infective endocarditis; methicillin-resistant antecubital fossa prior to
staphylococcus aureus; MRSA; transesophageal presentation at his local
Military Treatment Facility.
echocardiogram; transthoracic echocardiogram

Introduction
We describe an otherwise healthy Army Officer with infectious
endocarditis (IE) after being hospitalized with a heat injury
while participating in Special Forces Assessment and Selec-
tion (SFAS). Most cases of IE are associated with congenital The next day, his blood cultures were positive, and a trans-
heart disease or intravenous (IV) drug use, and our patient had thoracic echocardiogram (TTE) was performed with no signs
neither of those risk factors. His condition was an iatrogenic of vegetation. Two days later, the blood culture analysis con-
1
consequence of his heat injury treatment. firmed methicillin-resistant Staphylococcus aureus (MRSA).
The patient was transferred to a large civilian medical cen-
ter with transesophageal echocardiogram (TEE) capabilities,
Case Presentation
where a 2.5×0.5cm mobile echo density on the ventricular side
We present the case of a 26-year-old male with native heart of the pulmonic valve was identified, confirming the diagno-
valves, no underlying heart conditions, and no prior IV drug sis of MRSA endocarditis using Duke Criteria. The patient
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use who presented to his local Military Treatment Facility was hospitalized for 10 days and required left brachial vein
(MTF) with a fever, skin lesions, and pain at his IV site after excision for source control. The post-surgical site is depicted
a recent hospitalization. He had been hospitalized one week in Figure 3. He completed a 6-week course of outpatient dap-
before in rural North Carolina at a civilian medical center af- tomycin self-administered via a peripherally inserted central
ter a heat injury in the field while participating in SFAS. He catheter (PICC) line. After multiple readmissions for MRSA

*Correspondence to 2/160th SOAR (Abn), 650 Joel Drive Fort Campbell, KY 42223 or joseph.w.jude.mil@health.mil
1 SSG Garrett Maurice is a Special Operations Flight Medic affiliated with 2/160th SOAR (Abn), Fort Campbell, KY. SSG Christopher Freeman
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is a Special Operations Flight Medic affiliated with 2/160th SOAR (Abn), Fort Campbell, KY. CPT Adam Spanier is a Flight Surgeon affiliated
with 3/160th SOAR (Abn), Hunter Army Airfield, Savannah, GA. CPT Joseph Jude is a Flight Surgeon affiliated with 2/160th SOAR (Abn), Fort
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Campbell, KY.
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