From Device to Disease: Tricuspid Valve Replacement in a Patient with Copper T Associated Endocarditis and Thrombotic Thrombocytopenic Purpura

Background: Infective endocarditis involving the tricuspid valve is rare, typically seen in intravenous drug users or patients with indwelling vascular devices. Intrauterine device (IUD)-associated infective endocarditis is exceedingly uncommon, with very few cases documented. Even more unusual is the concomitant occurrence of thrombotic thrombocytopenic purpura (TTP), a rare and life-threatening thrombotic microangiopathy, in the setting of infective endocarditis. Here, we report a rare case of Copper T-associated tricuspid valve infective endocarditis complicated by TTP requiring surgical valve replacement and aggressive medical therapy. 1. Habib G, Lancellotti P, Antunes MJ, et al. 2015 ESC Guidelines for the management of infective endocarditis. European Heart Journal. 2015;36(44):3075-3128. 2. Miro JM, Anguera I, Cabell CH, et al. Infective endocarditis due to Staphylococcus aureus: a contemporary picture. Medicine (Baltimore). 2005;84(5):361-368. 3. Farley TM, Rosenberg MJ, Rowe PJ, et al. Intrauterine devices and pelvic inflammatory disease: an international perspective. The Lancet. 1992;339(8796):785–788. 4. Grimes DA. Intrauterine device and upper-genital-tract infection. The Lancet. 2000;356(9234):1013-1019. 5. George JN. How I treat patients with thrombotic thrombocytopenic purpura: 2010. Blood. 2010;116(20):4060-4069. 6. Scully M, Hunt BJ, Benjamin S, et al. Guidelines on the diagnosis and management of thrombotic thrombocytopenic purpura and other thrombotic microangiopathies. British Journal of Haematology. 2012;158(3):323-335. 7. Wang A, Gaca JG, Chu VH. Management considerations in infective endocarditis: a review. JAMA. 2018;320(1):72– 83. 8. Biedenharn KR, Thompson AM, Lichliter MA. A rare case of IUD-associated endocarditis. Infect Dis Obstet Gynecol. 2010; 2010:1–4. 9. Heinonen PK. Intrauterine contraceptive device and pelvic inflammatory disease: a prospective study. Contraception. 1981;23(4):451–459. 10. George JN. Thrombotic thrombocytopenic purpura. N Engl J Med. 2006;354(18):1927–1935. 11. Tsai HM, Lian EC. Antibodies to von Willebrand factor– cleaving protease in acute thrombotic thrombocytopenic purpura. N Engl J Med. 1998;339(22):1585–1594. 12. Ridolfi RL, Bell WR. Thrombotic thrombocytopenic purpura: report of 25 cases and review of the literature. Medicine (Baltimore). 1973;52(6):479–512.