ABSTRACT
Infective endocarditis (IE) poses a diagnostic challenge due to its diverse clinical presentations, especially among high-risk groups. Diagnosis relies on integrating clinical presentation, blood cultures and imaging findings. Advanced imaging techniques enhance diagnostic accuracy, particularly in complex cases. Treatment involves antimicrobial therapy and surgery in complicated cases, with early intervention crucial for optimal outcomes. Coordinated care by an Endocarditis Team ensures tailored treatment plans, prompt complication management and long-term monitoring after discharge. The authors present a case of subacute IE presenting initially with back pain in a patient with a complex medical history, highlighting diagnostic and management approaches.
Subject(s)
Back Pain , Endocarditis, Subacute Bacterial , Humans , Back Pain/etiology , Endocarditis, Subacute Bacterial/diagnosis , Endocarditis, Subacute Bacterial/complications , Endocarditis, Subacute Bacterial/drug therapy , Male , Anti-Bacterial Agents/therapeutic use , Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/complications , Endocarditis, Bacterial/microbiology , Middle Aged , Diagnosis, DifferentialABSTRACT
BACKGROUND Posterior reversible encephalopathy syndrome (PRES) is a poorly characterized and enigmatic syndrome. Despite consistently presenting with nervous system vasogenic edema, this malady has been associated with variable triggers, neurological symptoms, and natural history. CASE REPORT The report presents a 25-year old African American female who presented with altered mental status and bilateral cortical blindness. Neuroimaging identified vasogenic edema in the cerebellum, parietal lobe, and occipital lobe. Her PRES was associated with a hypertensive emergency, renal failure, and an atrial septum vegetation (culture-negative endocarditis). All 3 contributing etiologies were addressed, upon which the patient began to recover. During recovery, the patient experienced cerebral metamorphopsia, visualizing her entire environment in the form of a cartoon. After 2 weeks of treatment she recovered to baseline state of heath, with vasogenic edema resolved on follow-up neuroimaging. CONCLUSIONS This case presents a rarely catalogued phenomena during PRES recovery, cerebral metamorphopsia, along with a new potential association (culture negative atrial septum endocarditis). The report also highlights how PRES recovery patients (with cortical blindness) should be explicitly assessed for cerebral metamorphopsia and Charles Bonnet syndrome - which may distress patients. Lastly, the atypical presentation of cerebellar vasogenic edema in our patient validates existing literature that PRES does not have a uniform picture and is not well served by its current name or proposed diagnostic criteria. Therefore, renaming the disorder to reversible vasogenic edema syndrome and derestricting the diagnostic criteria, may prevent clinicians from being discouraged when faced with diagnosing PRES in the face of atypical findings.
Subject(s)
Endocarditis, Subacute Bacterial/drug therapy , Hypertension/drug therapy , Kidney Diseases/therapy , Posterior Leukoencephalopathy Syndrome/diagnostic imaging , Posterior Leukoencephalopathy Syndrome/therapy , Vision Disorders/therapy , Adult , Anti-Bacterial Agents/therapeutic use , Antihypertensive Agents/therapeutic use , Ceftazidime/therapeutic use , Cerebrospinal Fluid Shunts , Diagnosis, Differential , Dialysis , Female , Humans , Vancomycin/therapeutic use , Vasodilator Agents/therapeutic useSubject(s)
Aortic Valve Insufficiency/diagnostic imaging , Endocarditis, Subacute Bacterial/diagnostic imaging , Streptococcal Infections/diagnosis , Vasculitis, Leukocytoclastic, Cutaneous/diagnosis , Viridans Streptococci/isolation & purification , Aged , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/therapeutic use , Aortic Valve/diagnostic imaging , Aortic Valve/pathology , Aortic Valve Insufficiency/complications , Aortic Valve Insufficiency/therapy , Ceftriaxone/administration & dosage , Ceftriaxone/therapeutic use , Echocardiography, Transesophageal , Endocarditis, Subacute Bacterial/complications , Endocarditis, Subacute Bacterial/drug therapy , Endocarditis, Subacute Bacterial/microbiology , Fatal Outcome , Heart Valve Diseases/diagnostic imaging , Heart Valve Diseases/surgery , Heart Valve Prosthesis , Humans , Male , Shock, Cardiogenic/mortality , Streptococcal Infections/complications , Streptococcal Infections/drug therapy , Streptococcal Infections/microbiology , Vasculitis, Leukocytoclastic, Cutaneous/drug therapy , Vasculitis, Leukocytoclastic, Cutaneous/etiologyABSTRACT
Aerococcus urinae has been found to cause urinary tract infection in elderly patients and has been reported as a rare cause of infective endocarditis associated with significant morbidity and death in adults. However, information regarding its occurrence in children is lacking. We report here the case of a pediatric patient with subacute A urinae infective endocarditis with mycotic aneurysms.
Subject(s)
Aerococcus/isolation & purification , Aneurysm, Infected/diagnostic imaging , Aneurysm, Infected/microbiology , Endocarditis, Subacute Bacterial/diagnostic imaging , Gram-Positive Bacterial Infections/diagnostic imaging , Aneurysm, Infected/surgery , Anti-Bacterial Agents/therapeutic use , Child , Computed Tomography Angiography , Endocarditis, Subacute Bacterial/drug therapy , Gram-Positive Bacterial Infections/drug therapy , Humans , Male , Penicillin G/therapeutic use , Pulmonary Artery/microbiology , Pulmonary Artery/surgery , Thoracotomy , Treatment OutcomeSubject(s)
Endocarditis, Subacute Bacterial/diagnosis , Endocarditis, Subacute Bacterial/microbiology , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Anti-Bacterial Agents/therapeutic use , Cloxacillin/therapeutic use , Diagnosis, Differential , Endocarditis, Subacute Bacterial/drug therapy , Exanthema/etiology , Fever/etiology , Humans , Male , Middle AgedSubject(s)
Anemia , Echocardiography, Transesophageal , Endocarditis, Subacute Bacterial , Mitral Valve Prolapse , Tomography, X-Ray Computed , Viridans Streptococci , Adult , Anemia/complications , Anemia/diagnostic imaging , Anemia/drug therapy , Anemia/microbiology , Endocarditis, Subacute Bacterial/complications , Endocarditis, Subacute Bacterial/diagnostic imaging , Endocarditis, Subacute Bacterial/drug therapy , Endocarditis, Subacute Bacterial/microbiology , Female , Humans , Mitral Valve Prolapse/complications , Mitral Valve Prolapse/diagnostic imaging , Mitral Valve Prolapse/drug therapy , Mitral Valve Prolapse/microbiologySubject(s)
Aortic Valve/microbiology , Bartonella Infections/diagnosis , Bartonella quintana/isolation & purification , Endocarditis, Subacute Bacterial/diagnosis , Endocarditis, Subacute Bacterial/microbiology , Adult , Amoxicillin/therapeutic use , Anti-Bacterial Agents/therapeutic use , Aortic Valve/pathology , Aortic Valve Insufficiency/diagnostic imaging , Aortic Valve Insufficiency/drug therapy , Aortic Valve Insufficiency/etiology , Aortic Valve Insufficiency/microbiology , Arthralgia/microbiology , Bartonella Infections/diagnostic imaging , Bartonella Infections/drug therapy , Bartonella Infections/microbiology , Doxycycline/therapeutic use , Electrocardiography , Endocarditis, Subacute Bacterial/diagnostic imaging , Endocarditis, Subacute Bacterial/drug therapy , Female , Gentamicins/therapeutic use , Heart Valve Diseases/diagnostic imaging , Heart Valve Diseases/drug therapy , Heart Valve Diseases/microbiology , Humans , Oxacillin/therapeutic use , Socioeconomic Factors , Treatment OutcomeSubject(s)
Anti-Bacterial Agents/toxicity , Endocarditis, Subacute Bacterial/drug therapy , Anti-Bacterial Agents/therapeutic use , Ceftriaxone/therapeutic use , Drug Therapy, Combination , Endocarditis, Subacute Bacterial/diagnosis , Erythema/etiology , Gentamicins/therapeutic use , Humans , Male , Purpura/etiology , Treatment Outcome , Vancomycin/therapeutic use , Young AdultABSTRACT
We present the rare case of a 76-year-old female with infective endocarditis (IE) caused by Candida glabrata. Immediately before developing the present infection, she developed IE with vegetation on the mitral annular calcification, which was caused by Streptococcus mitis and successfully treated with penicillin-G and gentamicin. However, her fever recurred, and she developed disseminated intravascular coagulation. Blood culture revealed C. glabrata, and echocardiography revealed new vegetation on the mitral valve. After 4 weeks of treatment with micafungin, prosthetic valve replacement was performed, followed by additional administration of micafungin for 4 weeks (total of 8 weeks). No relapse at 9 months after surgery has been observed. C. glabrata endocarditis is extremely rare and difficult to manage. Our case and review of past reported cases suggest that early diagnosis and initiation of treatment contribute to good prognosis of C. glabrata endocarditis.
Subject(s)
Candida glabrata , Candidiasis/etiology , Endocarditis, Subacute Bacterial/complications , Endocarditis, Subacute Bacterial/drug therapy , Streptococcus mitis , Aged , Anti-Bacterial Agents/therapeutic use , Antifungal Agents/therapeutic use , Candidiasis/blood , Candidiasis/diagnostic imaging , Candidiasis/therapy , Early Diagnosis , Echinocandins/therapeutic use , Echocardiography , Endocarditis, Subacute Bacterial/diagnostic imaging , Female , Gentamicins/therapeutic use , Heart Valve Prosthesis , Humans , Lipopeptides/therapeutic use , Micafungin , Penicillin G/therapeutic useABSTRACT
Univentricular heart is a complex cyanotic congenital heart malformation classically repaired during early childhood. Despite correction, a residual risk of infective endocarditis still persists and may be associated with a severe prognosis. We report the case of a 50 year-old woman with a known partially corrected univentricular heart in whom we diagnosed an infective endocarditis with a favorable evolution under antibiotics.
Subject(s)
Echocardiography , Endocarditis, Subacute Bacterial/diagnosis , Endocarditis, Subacute Bacterial/drug therapy , Heart Defects, Congenital/diagnosis , Heart Defects, Congenital/surgery , Heart Ventricles/abnormalities , Heart Ventricles/surgery , Postoperative Complications/diagnosis , Postoperative Complications/drug therapy , Streptococcal Infections/diagnosis , Streptococcal Infections/drug therapy , Streptococcus sanguis , Combined Modality Therapy , Echocardiography, Transesophageal , Electrocardiography , Female , Gentamicins/therapeutic use , Humans , Middle Aged , Prognosis , Vancomycin/therapeutic useABSTRACT
A 52 years old patient is hospitalized in June 2007 in the Cardiology Clinic of Cardiovascular Diseases Medical Institute in Iasi with suspected subacute infectious endocarditis. Echocardiography shows mobile vegetation on the pulmonary valve. Acremonium spp is isolated from blood cultures after 2 weeks of incubation. The patient was treated with fluconazole, but died after 3 months due to renal failure.
Subject(s)
Acremonium/isolation & purification , Endocarditis, Subacute Bacterial/diagnosis , Fungemia/diagnosis , Antifungal Agents/therapeutic use , Endocarditis, Subacute Bacterial/blood , Endocarditis, Subacute Bacterial/diagnostic imaging , Endocarditis, Subacute Bacterial/drug therapy , Fatal Outcome , Fluconazole/therapeutic use , Fungemia/blood , Fungemia/drug therapy , Hospitals, University , Humans , Inpatients , Male , Middle Aged , Renal Insufficiency/etiology , Treatment Failure , UltrasonographyABSTRACT
Subacute bacterial endocarditis (SBE) was invariably a fatal disease in the pre-penicillin era. The availability of sulfonamide antibiotics beginning in the mid-1930s raised hopes that they would be effective in SBE. Unfortunately, except in rare instances, they were not. This paper reviews the clinical experience with sulfonamides in the pre-penicillin period in treating patients with SBE. It presents in detail the case of Pasquale Imperato, who died from the disease at the age of 72 years on 30 November 1942. In so doing, it focuses on the medical management measures then available to treat patients with SBE and on the inevitable course of the illness once it began. Also discussed is the relationship of acute rheumatic fever and its sequela, rheumatic heart disease, to predisposing people to SBE and possible genetic factors. The well-known case of Alfred S. Reinhart, a Harvard Medical School student who died from SBE in 1931 and who kept a detailed chronicle of his disease, is also discussed and contrasted with Pasquale Imperato's case.
Subject(s)
Anti-Bacterial Agents/history , Endocarditis, Subacute Bacterial/history , Rheumatic Heart Disease/history , Sulfonamides/history , Aged , Anti-Bacterial Agents/therapeutic use , Endocarditis, Subacute Bacterial/complications , Endocarditis, Subacute Bacterial/drug therapy , History, 20th Century , Humans , Male , Massachusetts , New York City , Penicillins/history , Penicillins/therapeutic use , Rheumatic Heart Disease/complications , Rheumatic Heart Disease/drug therapy , Students, Medical/history , Sulfonamides/supply & distribution , Sulfonamides/therapeutic useSubject(s)
Aortic Aneurysm/diagnostic imaging , Aortic Rupture/diagnostic imaging , Endocarditis, Bacterial/diagnostic imaging , Aortic Aneurysm/surgery , Aortic Rupture/surgery , Aortic Valve/diagnostic imaging , Diagnosis, Differential , Endocarditis, Bacterial/drug therapy , Endocarditis, Bacterial/microbiology , Endocarditis, Subacute Bacterial/diagnosis , Endocarditis, Subacute Bacterial/drug therapy , Endocarditis, Subacute Bacterial/microbiology , Heart Valve Prosthesis Implantation , Humans , Male , Middle Aged , Streptococcus sanguis , UltrasonographyABSTRACT
The year 2010 marked the centennial of the Rockefeller University Hospital, one of the great philanthropic achievements of 20th-century science. For 100 years, the Hospital played a central role in the development and growth of medical science by enabling physician-scientists to make intensive study of human biology and disease. With ingenuity and devotion, they greatly enriched clinical medicine as well as basic biological science. This account emphasizes the founding and first half-century of the Hospital as it became a germinal center for clinical investigation. The second half of the century saw rapid change in medicine and health care with vexing problems, many yet unsolved. This history should serve as a call to arms for maintaining the linkage of science and medicine, supporting patient-oriented research as a basic discipline of medicine.
Subject(s)
Clinical Medicine/history , Hospitals, University/history , Physician's Role/history , Endocarditis, Subacute Bacterial/drug therapy , History, 20th Century , History, 21st Century , Humans , Laboratories, Hospital , New York , Penicillins/therapeutic use , Pneumonia, Pneumococcal/microbiology , Streptococcal Infections/drug therapy , Streptococcal Infections/microbiology , World War IIABSTRACT
The presentation of endocarditis varies from patient to patient, making it a difficult infection to diagnose correctly. While some patients will develop symptoms acutely over days, it may take weeks or months for symptoms to develop as in the case of subacute bacterial endocarditis.
Subject(s)
Endocarditis, Subacute Bacterial/diagnosis , Nurse Practitioners , Adult , Anti-Bacterial Agents/therapeutic use , Endocarditis, Subacute Bacterial/drug therapy , Endocarditis, Subacute Bacterial/physiopathology , Humans , MaleSubject(s)
Actinobacillus Infections/diagnosis , Aggregatibacter actinomycetemcomitans/isolation & purification , Endocarditis, Subacute Bacterial/diagnosis , Fingers/pathology , Hand Dermatoses/etiology , Actinobacillus Infections/complications , Actinobacillus Infections/diagnostic imaging , Actinobacillus Infections/drug therapy , Actinobacillus Infections/microbiology , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/therapeutic use , Aortic Valve/diagnostic imaging , Aortic Valve/microbiology , Ceftriaxone/administration & dosage , Ceftriaxone/therapeutic use , Ciprofloxacin/administration & dosage , Ciprofloxacin/therapeutic use , Drug Therapy, Combination , Edema/etiology , Endocarditis, Subacute Bacterial/complications , Endocarditis, Subacute Bacterial/diagnostic imaging , Endocarditis, Subacute Bacterial/drug therapy , Endocarditis, Subacute Bacterial/microbiology , Gentamicins/administration & dosage , Gentamicins/therapeutic use , Hand Dermatoses/pathology , Heart Valve Prosthesis , Hemorrhage/etiology , Humans , Male , Middle Aged , Nail Diseases/etiology , Rheumatic Heart Disease/complications , UltrasonographyABSTRACT
A 19-year-old male patient was diagnosed with S. sanguinis brain abscess of unknown etiopathology as a complication of subclinical endocarditis. While viridans streptococci are implicated in dental seeding to the heart, S. sanguinis brain abscesses are rare. Six previous cases of S. sanguinis brain abscess in the literature reported dental procedures and maxillofacial trauma. In our patient, there was no obvious source of infective endocarditis preceding the development of brain abscess. This demonstrates the importance of prompt diagnosis and initiation of antimicrobial therapy given the potential for long-term sequelae such as focal deficits and seizures.
Subject(s)
Brain Abscess/diagnosis , Endocarditis, Subacute Bacterial/complications , Endocarditis, Subacute Bacterial/diagnosis , Streptococcal Infections/diagnosis , Streptococcus sanguis , Anti-Bacterial Agents/therapeutic use , Brain Abscess/drug therapy , Combined Modality Therapy , Craniotomy , Drug Therapy, Combination , Early Diagnosis , Echocardiography, Doppler, Color , Echocardiography, Transesophageal , Endocarditis, Subacute Bacterial/drug therapy , Humans , Magnetic Resonance Imaging , Male , Mitral Valve Insufficiency/diagnosis , Streptococcal Infections/drug therapy , Tomography, X-Ray Computed , Young AdultABSTRACT
We report the first successful application of nonferromagnetic embolization coils for endovascular exclusion of a mycotic right subclavian artery aneurysm. A 58-year-old woman presented with acute cervical pain and a pulsatile mass in the right supraclavicular fossa under antibiotic medication for subacute infectious endocarditis. Diagnostic work-up including duplex sonography, digital subtraction angiography, and magnetic resonance imaging demonstrated a saccular aneurysm of the extrathoracic right subclavian artery. As an alternative to open surgery or stent-graft repair, this pathology was electively treated by transcatheter coil embolization. No neurological deficit or ischemic symptoms were noted during 9 months clinical follow-up. Multislice computed tomography scan revealed complete occlusion of the mycotic aneurysm 6 months after the interventional procedure. Transcatheter closure with Inconel embolization coils is a cost-effective and safe therapeutic option in patients with mycotic aneurysm originating from the subclavian artery.
Subject(s)
Aneurysm, Infected/therapy , Embolization, Therapeutic , Endocarditis, Subacute Bacterial/microbiology , Subclavian Artery , Aneurysm, Infected/diagnosis , Aneurysm, Infected/microbiology , Angiography, Digital Subtraction , Anti-Bacterial Agents/therapeutic use , Embolization, Therapeutic/instrumentation , Endocarditis, Subacute Bacterial/drug therapy , Female , Humans , Magnetic Resonance Angiography , Middle Aged , Subclavian Artery/diagnostic imaging , Subclavian Artery/microbiology , Time Factors , Tomography, X-Ray Computed , Treatment Outcome , Ultrasonography, Doppler, DuplexABSTRACT
Endogenous endophthalmitis is a rare complication of infective endocarditis and has been decreasing due to the availability of effective antibiotics. We highlight a case of endogenous endophthalmitis due to levofloxacin-resistant Streptococcus mitis presenting as infective endocarditis. Endogenous endophthalmitis should be considered as a manifestation of an underlying systemic disease, especially in patients who present with non-specific signs and symptoms with no obvious source of precipitating infection.