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Syndrome of inappropriate antidiuretic hormone secretion — USMLE Step 2 CK MCQ

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HardInternal MedicineSyndrome of inappropriate antidiuretic hormone secretionUSMLE Step 2 CK

A man receiving appropriate antibiotics for aortic-valve infective endocarditis develops a new prolonged PR interval and then complete atrioventricular block. Fever and bacteremia persist. Which complication and management are most likely?

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Correct answer: E — Periannular abscess requiring urgent surgical evaluation

New conduction disease during aortic-valve endocarditis suggests extension into the periannular tissue near the conduction system, often an aortic-root abscess. Persistent infection plus new AV block is evidence of locally uncontrolled infection and warrants urgent transesophageal imaging and early valve-team surgical evaluation in addition to antibiotics. Observation or simply extending antibiotics risks fistula, heart block and ongoing sepsis. Pericarditis does not explain this characteristic progression, and fibrinolysis is hazardous in infective endocarditis.

Reference: American College of Cardiology: Endocarditis guideline key points. https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2023/08/29/20/49/2023-esc-guidelines-for-endocarditis-esc-2023