Infective Endocarditis in a Pregnant Female with Chronic Sialadenitis Associated with Gingivobuccal Sulcus Malignancy: A Rare Presentation OD01-OD03
Dr. Sakshi Gagneja,
Flat No. 304, Darshika Apartments, Ratnakar Sabhagrah, Warun Road, Near Naveen Tiles, Sewagram, Wardha, Maharashtra, India.
Infective Endocarditis (IE) in cancer is not very frequently reported. We report an interesting case of a 27-year-old primigravida with 30 weeks pregnancy, who presented with high grade fever with severe anaemia and thrombocytopenia. Twenty days before this presentation, she was evaluated for a gingivobuccal sulcus mass in this hospital, oral examination had revealed a soft, bluish, non-tender patch on her left gingivobuccal sulcus; as per her old document (clinical picture was retrieved from Department of Oral and Maxillofacial Surgery) for which a biopsy was done. Biopsy revealed chronic sialadenitis with metaplastic changes of mucoepidermoid carcinoma. In search of the cause of her fever with anaemia and thrombocytopenia, exhaustive investigations were done but were inconclusive. Dilemma occurred, when she developed preterm labour at 32 weeks and post-delivery, she went into respiratory distress. Embolism was kept as a differential but CT Pulmonary angiography was negative. Then, 2D-ECHO showed a vegetation on the mitral valve. Three sets of blood cultures obtained from different venipuncture sites at 12 hourly intervals were negative however, she responded to intravenous antibiotics. We presume that the chronic sialadenitis associated with malignancy lead to the blood stream dissemination of organisms from oral cavity to native valves causing endocarditis.