Heartbreak From Puppy Love: A Case of Pasteurella multocida Endocarditis and Review of the Literature

Abstract

Background Pasteurella multocida, a gram-negative coccobacillus associated with dog, cat, and other animal contact, often causes human bite infection, cellulitis, and osteomyelitis, but infective endocarditis is rare. We present a patient with P. multocida aortic valve endocarditis whose animal exposure was contact with his dog's saliva from frequent licking of patient's skin in the perioral area. Case Presentation A 62-year-old man with successfully treated hepatitis C presented to hospital after a syncopal episode while chasing his dog. He had previously noted night sweats, fever, generalized weakness, and dyspnea on exertion. He denied bites or scratches but admitted allowing his dog to lick around his mouth. On presentation, he was in septic shock with lactic acidosis. White blood cell count was 20,000/μL. Pasteurella multocida was isolated from both admission blood cultures. The patient was treated with antimicrobial therapy and resuscitated. Transthoracic echocardiogram revealed critical bicuspid aortic valve stenosis with root abscess and ascending aortic aneurysm. Transesophageal echocardiogram showed reduced ejection fraction and severe aortic stenosis but no definitive vegetations. At surgery, there were nodular lesions on the aortic valve, left ventricular outflow tract perforation, and annular abscess of aortic valve. He had mechanical aortic valve replacement, annular reconstruction, and aortic aneurysm repair. The patient received 6 weeks of postoperative intravenous ceftriaxone and remained infection-free at 1-year follow-up visit.