minocycline and Aortic-Valve-Insufficiency

We describe the case of a 75-year-old male with pyoderma gangrenosum (PG) who had severe aortic insufficiency and moderate mitral regurgitation. He had been taking minocycline for 15 years to treat PG. He underwent aortic valve replacement and mitral valve repair. Aortotomy revealed a black discoloration of the aortic valve and sinus of Valsalve.

Topics: Aged; Anti-Bacterial Agents; Aortic Valve Insufficiency; Humans; Male; Minocycline; Mitral Valve Insufficiency; Pigmentation Disorders; Pyoderma Gangrenosum

The treatment of recurrent prosthetic valve endocarditis is extremely difficult. Heart transplantation (HT) may save the patient's life. Recurrent endocarditis, however, can occur after HT. This report described a patient who had under gone four conventional valve surgeries and three HTs successfully. In May 2000, a 14-year-old boy suffered from endocarditis with severe aortic valve regurgitation. He underwent aortic valve replacement (AVR) at another hospital. Due to prosthetic valve endocarditis, he displayed a severe paravalvular leakage and was transferred to our hospital where he underwent Bentall's operation in October 2000. Despite a full antibiotic course, he experienced a relapse of the prosthetic endocarditis with significant deterioration of the heart function and a progressively more severe paravalvular leak. Considering the difficulties of repair and the poor heart function, he underwent an HT in June 2003 and recovered well. Unfortunately, endocarditis with aortic valve regurgitation attacked him again after 3 years. Remarkably, all blood cultures were negative. A second AVR was performed in October 2006 with a Second Bentall's procedure 1 year later in 2007. In November 2009, the patient suddenly displayed cardiogenic shock with collapse. He was transferred to our hospital and needed extracorporcal membrane oxygenation (ECMO) support. Two days later, he underwent a second HT. However, the donor heart was nonfunctional due to the prolonged ischemia time. ECMO support was continuously needed after the HT. A third HT was performed successfully 10 days later. Due to previous reported experiences of culture-negative endocarditis, minocycline was prescribed twice daily continuously after the third HT/seventh cardiac surgery. The patient was discharged 2 months later. To date he takes minocycline every day and lives a healthy life.

Topics: Adolescent; Anti-Bacterial Agents; Aortic Valve Insufficiency; Drug Administration Schedule; Endocarditis; Heart Transplantation; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Male; Minocycline; Prosthesis-Related Infections; Recurrence; Reoperation; Time Factors; Treatment Outcome

Topics: Aged; Alcaligenes; Aortic Valve Insufficiency; Cross Infection; Drug Therapy, Combination; Humans; Hypertension; Male; Minocycline; Sepsis; Vancomycin