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Case of the Month - February 2016

Case of the month - High risk feto-maternal obstetrics – February 2016

N. Naidoo, S. Foolchand, K. Swe Swe Han, K. Mlisana

Nireshan Naidoo, Senior pathology registrar, Department of Medical Microbiology, National Health Laboratory Service, University of KwaZulu-Natal, Durban

Serantha Foolchand, Specialist consultant, Feto-Maternal Obstetrics, Department of Obstetrics and Gynaecology, Inkosi Albert Luthuli Central Hospital, University of KwaZulu-Natal, Durban

Khine Swe Swe Han, Senior pathologist and consultant, Department of Medical Microbiology, National Health Laboratory Service, University of KwaZulu-Natal, Durban

Koleka Mlisana, Head of Department, Senior pathologist and consultant, Department of Medical Microbiology, National Health Laboratory Service, University of KwaZulu-Natal, Durban

A 22-year-old Para0 Gravida1 female with a dual valve prosthetic replacement, 2 years previously, presented at 8 weeks’ gestation for intravenous anticoagulation to prevent thromboembolic complications during the pregnancy. She was HIV seronegative, RH positive and RPR negative. Blood cultures (separate sites, over different days) cultured Acinetobacter baumanii with MIC’s susceptible to 4 antibiotic classes – beta lactam (piperacillin/tazobactam and meropenem), a fluoroquinolone (ciprofloxacin), an aminoglycoside (amikacin) and a polymyxin (colistin). Although transthoracic echocardiography revealed no prosthetic valvular abnormalities, subsequent trans-oesophageal echocardiography (TOE) showed early abscess formation around the posterior aspect of the aortic valve (AV) ring. She was not a candidate for surgical intervention was therefore managed conservatively.


Question 1: What is the most likely diagnosis? Give reasons to support your answer above.


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