Non-Tuberculous Mycobacterial Infective Endocarditis Following Percutaneous Coronary Intervention: A Case Series

Non-tuberculous mycobacteria (NTM) are infrequent however increasingly appreciated etiologies of infective endocarditis (IE), especially in the setting of healthcare-related exposures. Culture negativity and clinical overlap with tuberculosis, particularly in endemic areas, renders diagnosis difficult. We presented three lethal cases of NTM-associated native valve IE, developing post-percutaneous coronary intervention (PCI) in Bangladesh. All patients had sustained fever and systemic features after coronary stenting. A delay in the diagnosis was common because of negative routine cultures and initial misdiagnosis of tuberculosis. Rapid-growing NTM were identified with by a lengthened culture, and echocardiography suggested possible thrombus. Although a combination antibiotic therapy was introduced with amikacin, macrolides and linezolid, there was little clinical improvement. One patient was operated, all three patient died. These cases demonstrate the importance of keeping in mind NTM in febrile sick patient after PCI, even if cultures are negative. Early suspicion, specific diagnosis, and aggressive medical and surgical therapy are essential for better outcomes in NTM IE. ​