From Commensal to Catastrophic: Coagulase-Negative Staphylococcus Infection to Cardiac Transplantation

Background: Infective endocarditis caused by coagulase-negative staphylococci (CoNS) is increasingly recognized in patients with prosthetic valves and intracardiac devices.Although traditionally considered low-virulence organisms, CoNS-particularly Staphylococcus epidermidis-can cause destructive prosthetic valve infective endocarditis through biofilm formation, antimicrobial resistance, and periannular extension.Management is challenging, and outcomes are poor when infection is refractory to medical and surgical therapies.Case Report: A 47-year-old female with a bioprosthetic mitral valve and multiple comorbidities, including stage 3B invasive ductal carcinoma, presented with cardiogenic shock, complete heart block, and multiorgan hypoperfusion.Echocardiography revealed severe biventricular dysfunction, severe aortic stenosis with regurgitation, and mobile echodensities on both the aortic and bioprosthetic mitral valves, as well as on intracardiac catheters.Blood cultures grew S epidermidis, confirming prosthetic valve infective endocarditis.Despite broad-spectrum antibiotics, mechanical circulatory support, and multidisciplinary evaluation, the patient remained in refractory cardiogenic shock and developed multiple cardioembolic cerebral infarcts, precluding definitive valve surgery.Given the extensive valvular involvement, neurologic complications, and failure of conventional therapies, orthotopic heart transplantation was pursued as a salvage strategy.The patient underwent successful transplantation on hospital day 40, followed by prolonged postoperative antimicrobial therapy and carefully tailored immunosuppression in the setting of active malignancy.Conclusion: This case highlights the aggressive potential of CoNS prosthetic valve infective endocarditis and underscores its diagnostic and therapeutic challenges.In select patients with intractable infection, extensive valvular destruction, and refractory cardiogenic shock, orthotopic heart transplantation may be a lifesaving option for definitive infection eradication when standard surgical approaches are not feasible.