A Case of Endocarditis Secondary to Bacteremia Caused by Obstructive Pyelonephritis From Infective Nephrolithiasis in the Setting of Untreated Hyperparathyroidism

Hyperparathyroidism is known to be associated with nephrolithiasis but has less frequently been reported to contribute to infective endocarditis. We report a case of a 56-year-old woman with a past medical history of parathyroid adenoma, hyperparathyroidism, hypercalcemia, nephrolithiasis requiring bilateral nephrostomy, multiple episodes of complicated urinary tract infection (UTI), pulmonary and cardiac sarcoidosis treated with steroids previously, and intermittent complete heart block with implantable cardioverter-defibrillator (ICD), who presented to the ED with septic shock. She was found to have Enterococcus faecalis bacteremia complicated by large vegetations on her right ventricle ICD lead and tricuspid valve. Urinalysis was positive for leukocyte esterase, WBC, RBC, and bacteria. Transabdominal ultrasound and CT abdomen/pelvis showed multiple renal stones in bilateral kidneys. Nephrolithiasis secondary to untreated primary hyperparathyroidism had likely caused acute obstructive pyelonephritis in the patient, which had progressed to bacteremia and septic shock eventually leading to infective endocarditis. The patient was started on a six-week course of IV ceftriaxone and ampicillin, had her ICD removed, her blood cultures cleared, and was then referred to ENT and Endocrinology for parathyroidectomy. Prompt identification and treatment of hyperparathyroidism including parathyroidectomy can reduce the risk of nephrolithiasis and serious infections.