ABSTRACT
The role of antibiotic prophylaxis for prevention of infective endocarditis is unknown. Endocarditis prophylaxis is recommended for certain high-risk individuals prior to dental procedures. To our knowledge, this is the first case reported in the literature of a patient with complex congenital heart disease developing endocarditis in the period immediately following otherwise uncomplicated intrauterine device insertion.
Subject(s)
Endocarditis, Bacterial/diagnosis , Heart Valve Prosthesis/microbiology , Intrauterine Devices/microbiology , Prosthesis-Related Infections/diagnosis , Tetralogy of Fallot/drug therapy , Adult , Antibiotic Prophylaxis , Cardiovascular Surgical Procedures , Dental Care , Dental Care for Chronically Ill/standards , Endocarditis, Bacterial/therapy , Female , Humans , Intrauterine Devices/adverse effects , Prosthesis-Related Infections/therapy , Risk Factors , Tetralogy of Fallot/complications , Treatment OutcomeABSTRACT
A 37-year-old woman with a history of inflammatory bowel disease on mercaptopurine presented with a week of recurrent fever, headache, myalgias and mildly elevated serum transaminases and leucopenia. Her workup revealed primary cytomegalovirus (CMV) infection with atypical lymphocytosis, elevated viral load, positive IgM and negative IgG. Two weeks after her initial presentation, she developed odynophagia and diarrhoea prompting endoscopic evaluation with biopsies, which demonstrated CMV disease of the gastrointestinal tract. Her fever and systemic symptoms improved rapidly with initiation of intravenous ganciclovir. She was transitioned to and maintained on oral valganciclovir until two and half months after discharge when her symptoms and lab abnormalities had fully subsided.