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TOPIC: Chest Infections TYPE: Fellow Case Reports INTRODUCTION: Aortic root abscess is a lethal complication of infective endocarditis. Here, we report a case of aortic root abscess that occurred as a complication of S. epidermidis prosthetic valve endocarditis, which is a rare cause of aortic abscess. CASE PRESENTATION: 71-year-old woman with complex cardiac history including a bioprosthetic aortic valve replacement, ascending aorta aneurysm repair, and coronary artery bypass graft x4 presented to the ER with worsening chest pain, fevers, chills and rigors. On arrival, temperature was 97.5°F heart rate was 61 beats/min, respiratory rate was 20 per minute and blood pressure was 139/82 mm Hg. On exam, she had a grade 4/6 ejection systolic murmur, heard best at the right upper sternal border radiating to carotids. Laboratory investigations showed hemoglobin, 10.5 g/ dL;total leukocyte count, 10 k/uL with 80% neutrophils;platelet count, 311 k/uL;and sedimentation rate, 74 mm/hr. Rest of the labs were normal. She tested negative for SARS-Cov-2 by polymerase chain reaction (PCR). Blood cultures grew isolated Staphylococcus epidermidis. She was persistently bacteremic on vancomycin monotherapy and required ceftaroline and daptomycin combination therapy for clearance of bacteremia. Transesophageal echo cardiography was obtained which showed an area of echolucency adjacent to the posterior aortic valve annulus suggestive of abscess. PET CT was obtained, confirmed the diagnosis of aortic abscess. She was referred to Mayo Clinic. She underwent, extensive debridement of previously implanted tissue aortic valve and entire root complex, coronary artery bypass grafting and aortic root replacement. DISCUSSION: Aortic root abscess is a life-threatening complication of aortic valve endocarditis, known to occur in patients with native and prosthetic aortic valves. Staphylococcus aureus is the reported as most common cause. Persistent fever, shortness of breath, chest pain and other signs of severe aortic regurgitations are the most common presentation. Aggressive surgical debridement and medical therapy are the key to treatment. If untreated, can result in severe valvular dysfunction, fistula formation, perforation of cusps, pseudoaneurysm, obstruction of coronary flow or fatal arrhythmia. Even with surgery, reported mortality remains high 12.2-30%. CONCLUSIONS: Aortic root abscess should be considered as a diagnosis in persistently febrile and bacteremic patients with prosthetic valve endocarditis and should be treated promptly with surgical debridement and reconstruction. REFERENCE #1: Chen G-J, Lo W-C, Tseng H-W, Pan S-C, Chen Y-S, Chang S-C. Outcome of surgical intervention for aortic root abscess: a meta-analysis. Eur J Cardiothorac Surg 2018;53:807–14 DISCLOSURES: No relevant relationships by Rosa Cruz Torres, source=Web Response No relevant relationships by Dorothy Kenny, source=Web Response No relevant relationships by Sanu Rajendraprasad, source=Web Response No relevant relationships by Manasa Velagapudi, source=Web Response