TNF-α inhibitor therapy and prosthetic aortic valve endocarditis: a case report

Tumor necrosis factor-alpha (TNF-α) inhibitors and other biologics used for autoimmune diseases are associated with low-grade immunosuppression. Treatment with these and the presence of prosthetic mechanical cardiac valves both increase the risk of infective endocarditis (IE). However, evidence on the risk of prosthetic valve endocarditis (PVE) among patients treated with TNF-α inhibitors is limited. This study reports a 41-year-old man with a prosthetic aortic valve who was on treatment with golimumab and presented with low-grade fevers and positive blood cultures for <i>Staphylococcus epidermidis</i>. Transesophageal echocardiogram revealed vegetations adjacent to the valve sewing ring and an inflammatory phlegmon in the right atrium, leading to a diagnosis of prosthetic valve endocarditis. The patient was referred to a higher level of care center and underwent urgent surgical intervention. The study highlights that TNF-α inhibitors and other biologics may increase the risk of prosthetic heart valve endocarditis and the importance of early imaging for diagnosis.