RESUMO
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.
Assuntos
Dor nas Costas , Endocardite Bacteriana Subaguda , Humanos , Dor nas Costas/etiologia , Endocardite Bacteriana Subaguda/diagnóstico , Endocardite Bacteriana Subaguda/complicações , Endocardite Bacteriana Subaguda/tratamento farmacológico , Masculino , Antibacterianos/uso terapêutico , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/complicações , Endocardite Bacteriana/microbiologia , Pessoa de Meia-Idade , Diagnóstico DiferencialRESUMO
In 1961, K Merendino 'in pure curiosity', while tracking the murmur of mitral regurgitation, placed his stethoscope 'on the vertex of the head', and ultimately led to a medical curiosity and exam finding that not only bears his name, but awes medical learners at all stages of their careers. Merendino and colleagues collected seven such cases of the 'Murmur on Top of the Head' building on the work of others who provided a detailed description of mitral regurgitation and noted murmur radiation to the neck and cervical/lumbosacral spine. The majority of patients suffered from rheumatic heart disease or subacute bacterial endocarditis in native heart valves. Here, we report on a case of the 'Murmur on Top of the Head' and provide the reader/listener with a direct recording of the 'Merendino murmur' (as well as its spinal correlate) in an elderly woman with a bioprosthetic mitral valve.
Assuntos
Endocardite Bacteriana Subaguda , Insuficiência da Valva Mitral , Cardiopatia Reumática , Idoso , Feminino , Sopros Cardíacos/diagnóstico , Sopros Cardíacos/etiologia , Humanos , Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/etiologiaRESUMO
RATIONALE: Several renal diseases are associated with infectious endocarditis. However, there are few reports on patients with granulomatosis with polyangiitis (GPA) associated with infectious endocarditis, and there is no consensus for appropriate treatment. PATIENTS CONCERNS: A 35 -years-old man with congenital ventricular septal defect presented severe anemia, hematuria and proteinuria. The blood and urine examinations showed elevated white blood cells (12,900âcells/µL), C-reactive protein level (13.1âmg/dL) and proteinase 3-anti-neutrophil cytoplasmic antibody (PR3-ANCA) level (11.0âIU/mL), severe anemia (hemoglobin: 6.1âg/dL) and renal dysfunction [estimated glomerular filtration rate (eGFR): 12.7âml/min.1.78 m2 with hematuria and proteinuria]. DIAGNOSES: The patient was diagnosed with crescentic glomerulonephritis with histological features of GPA associated with infectious endocarditis by renal biopsy and transthoracic echocardiography. INTERVENTIONS: Antibacterial drugs (ampicillin-sulbactam) were administrated. No immunomodulating agents were used because immunosuppressive drugs may worsen infectious endocarditis. Subsequently, renal function and urinary findings improved. However, infectious endocarditis was not improved. Therefore, valve replacements and ventricular septal closure surgery were conducted. OUTCOMES: Thereafter, his postoperative course was uneventful, renal function improved (eGFR: 64.3âml/min.1.78 m2), and PR3-ANCA level normalized. LESSONS: We reported a case report of PR3-ANCA positive glomerulonephritis with histological features of GPA associated with infectious endocarditis. Physicians might note this renal complication when they manage infectious endocarditis.
Assuntos
Anticorpos Anticitoplasma de Neutrófilos/imunologia , Endocardite Bacteriana Subaguda/complicações , Glomerulonefrite/etiologia , Granulomatose com Poliangiite/complicações , Adulto , Biópsia , Glomerulonefrite/diagnóstico , Glomerulonefrite/imunologia , Granulomatose com Poliangiite/diagnóstico , Granulomatose com Poliangiite/imunologia , Humanos , Rim/patologia , MasculinoRESUMO
Hemolytic anemia is a rarely occurring manifestation of native valve infective endocarditis. We herein report an afebrile patient with hemolytic anemia caused by Cardiobacterium hominis endocarditis. A 60-year-old Japanese man had a history of aortic root replacement and the gradual onset of general fatigue. He had hemolytic anemia. Blood cultures detected C. hominis. A transthoracic echocardiogram showed aortic valve vegetation and periannular abscess with perforation of the non-coronary cusp. Intravascular hemolysis recovered after antimicrobial therapy, surgical removal of the vegetation and abscess, and aortic valve replacement. Subacute endocarditis should be considered if patients develop hemolytic anemia with signs of chronic inflammation without a fever.
Assuntos
Anemia Hemolítica , Cardiobacterium , Endocardite Bacteriana , Endocardite Bacteriana Subaguda , Infecções por Bactérias Gram-Negativas , Anemia Hemolítica/diagnóstico , Anemia Hemolítica/etiologia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/diagnóstico , Infecções por Bactérias Gram-Negativas/complicações , Infecções por Bactérias Gram-Negativas/diagnóstico , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
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.
Assuntos
Endocardite Bacteriana Subaguda/tratamento farmacológico , Hipertensão/tratamento farmacológico , Nefropatias/terapia , Síndrome da Leucoencefalopatia Posterior/diagnóstico por imagem , Síndrome da Leucoencefalopatia Posterior/terapia , Transtornos da Visão/terapia , Adulto , Antibacterianos/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Ceftazidima/uso terapêutico , Derivações do Líquido Cefalorraquidiano , Diagnóstico Diferencial , Diálise , Feminino , Humanos , Vancomicina/uso terapêutico , Vasodilatadores/uso terapêuticoAssuntos
Insuficiência da Valva Aórtica/diagnóstico por imagem , Endocardite Bacteriana Subaguda/diagnóstico por imagem , Infecções Estreptocócicas/diagnóstico , Vasculite Leucocitoclástica Cutânea/diagnóstico , Estreptococos Viridans/isolamento & purificação , Idoso , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/patologia , Insuficiência da Valva Aórtica/complicações , Insuficiência da Valva Aórtica/terapia , Ceftriaxona/administração & dosagem , Ceftriaxona/uso terapêutico , Ecocardiografia Transesofagiana , Endocardite Bacteriana Subaguda/complicações , Endocardite Bacteriana Subaguda/tratamento farmacológico , Endocardite Bacteriana Subaguda/microbiologia , Evolução Fatal , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/cirurgia , Próteses Valvulares Cardíacas , Humanos , Masculino , Choque Cardiogênico/mortalidade , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/microbiologia , Vasculite Leucocitoclástica Cutânea/tratamento farmacológico , Vasculite Leucocitoclástica Cutânea/etiologiaRESUMO
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.
Assuntos
Aerococcus/isolamento & purificação , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/microbiologia , Endocardite Bacteriana Subaguda/diagnóstico por imagem , Infecções por Bactérias Gram-Positivas/diagnóstico por imagem , Aneurisma Infectado/cirurgia , Antibacterianos/uso terapêutico , Criança , Angiografia por Tomografia Computadorizada , Endocardite Bacteriana Subaguda/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Humanos , Masculino , Penicilina G/uso terapêutico , Artéria Pulmonar/microbiologia , Artéria Pulmonar/cirurgia , Toracotomia , Resultado do TratamentoAssuntos
Aneurisma Infectado/diagnóstico , Endocardite Bacteriana Subaguda/diagnóstico , Doenças Vasculares Periféricas , Infecções Estreptocócicas/diagnóstico , Streptococcus salivarius/isolamento & purificação , Artéria Ulnar , Adulto , Valva Aórtica/anormalidades , Endocardite Bacteriana Subaguda/complicações , Humanos , Masculino , Doenças Vasculares Periféricas/diagnóstico por imagem , Infecções Estreptocócicas/complicações , Tomografia Computadorizada por Raios X , Artéria Ulnar/diagnóstico por imagemAssuntos
Endocardite Bacteriana Subaguda/diagnóstico , Endocardite Bacteriana Subaguda/microbiologia , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Antibacterianos/uso terapêutico , Cloxacilina/uso terapêutico , Diagnóstico Diferencial , Endocardite Bacteriana Subaguda/tratamento farmacológico , Exantema/etiologia , Febre/etiologia , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Anemia , Ecocardiografia Transesofagiana , Endocardite Bacteriana Subaguda , Prolapso da Valva Mitral , Tomografia Computadorizada por Raios X , Estreptococos Viridans , Adulto , Anemia/complicações , Anemia/diagnóstico por imagem , Anemia/tratamento farmacológico , Anemia/microbiologia , Endocardite Bacteriana Subaguda/complicações , Endocardite Bacteriana Subaguda/diagnóstico por imagem , Endocardite Bacteriana Subaguda/tratamento farmacológico , Endocardite Bacteriana Subaguda/microbiologia , Feminino , Humanos , Prolapso da Valva Mitral/complicações , Prolapso da Valva Mitral/diagnóstico por imagem , Prolapso da Valva Mitral/tratamento farmacológico , Prolapso da Valva Mitral/microbiologiaRESUMO
No disponible
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Abscesso/complicações , Abscesso , Endocardite Bacteriana , Endocardite Bacteriana Subaguda , Tomografia por Emissão de Pósitrons/métodos , Tomografia por Emissão de Pósitrons , Fluordesoxiglucose F18/análise , Fluordesoxiglucose F18/administração & dosagem , Ecocardiografia , Staphylococcus aureus , Staphylococcus aureus/isolamento & purificação , Marca-Passo Artificial , Daptomicina/uso terapêutico , Gentamicinas/uso terapêuticoRESUMO
We herein report two cases of proteinase 3-anti-neutrophil cytoplasmic antibody (PR3-ANCA)-related nephritis in infectious endocarditis. In both cases, the patients were middle-aged men with proteinuria and hematuria, hypoalbuminemia, decreased kidney function, anemia, elevated C-reactive protein (CRP) levels, and PR3-ANCA positivity. Each had bacteremia, due to Enterococcus faecium in one and Streptococcus bovis in the other. One patient received aortic valve replacement therapy for aortic regurgitation with vegetation, and the other underwent tricuspid valve replacement therapy and closure of a ventricular septic defect to treat tricuspid regurgitation with vegetation. These patients' urinary abnormalities and PR3-ANCA titers improved at 6 months after surgery following antibiotic treatment without steroid therapy.
Assuntos
Anticorpos Anticitoplasma de Neutrófilos/imunologia , Endocardite Bacteriana Subaguda/complicações , Mieloblastina/imunologia , Nefrite/imunologia , Adulto , Endocardite Bacteriana Subaguda/imunologia , Humanos , Masculino , Nefrite/etiologiaAssuntos
Valva Aórtica/microbiologia , Infecções por Bartonella/diagnóstico , Bartonella quintana/isolamento & purificação , Endocardite Bacteriana Subaguda/diagnóstico , Endocardite Bacteriana Subaguda/microbiologia , Adulto , Amoxicilina/uso terapêutico , Antibacterianos/uso terapêutico , Valva Aórtica/patologia , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/tratamento farmacológico , Insuficiência da Valva Aórtica/etiologia , Insuficiência da Valva Aórtica/microbiologia , Artralgia/microbiologia , Infecções por Bartonella/diagnóstico por imagem , Infecções por Bartonella/tratamento farmacológico , Infecções por Bartonella/microbiologia , Doxiciclina/uso terapêutico , Eletrocardiografia , Endocardite Bacteriana Subaguda/diagnóstico por imagem , Endocardite Bacteriana Subaguda/tratamento farmacológico , Feminino , Gentamicinas/uso terapêutico , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/tratamento farmacológico , Doenças das Valvas Cardíacas/microbiologia , Humanos , Oxacilina/uso terapêutico , Fatores Socioeconômicos , Resultado do TratamentoRESUMO
BACKGROUND/AIM: Fewer of unknown origin (FUO) remains amongst the most difficult diagnostic dilemmas in contemporary medicine. The aim of this study was to determine the causes of FU and to identify the methods of diagnosis in patients with FUO in a tertiary care setting in the Republic of Macedonia. METHODS: Retrospectively histories of 123 immunocompetent patients older than 14 years with classical FUO that had been examined at the University Hospital for Infectious Diseases and Febrile Conditions in the city of Skopje, during the period 2006-2012 were evaluated. FUO was defined as axillary fever of ≥ 37.5 °C on several occasions, fever duration of more than 21 days and failure to reach the diagnosis after the initial diagnostic workup comprised of several defined basic investigations. RESULTS: Infections were the cause of FUO in 51 (41.5%) of the patients, followed by non-infective inflammatory disorders (NIID) in 28 (22.8%), miscellaneous in 12 (9.7%) and neoplasm in 11 (8.9%) of the patients. Twenty one of the patients (17.1%) remained undiagnosed. The most common causes for FUO were visceral leishmaniasis, abscesses, urinary tract infections, subacute endocarditis, polymyalgia rheumatica and adult onset of Still disease. The final diagnosis was reached with histology in 24 (23.5%), imaging and endoscopic procedures in 21 (20.6%), clinical course and empiric therapy response in 20 (19.6%), serology in 18 (17.6%) and cultures in 16 (15.7%) of the cases. CONCLUSION: In the Republic of Macedonia infections are the leading cause of FUO, predominately visceral leishmaniasis. In the future in patients with prolonged fever, physicians should think more often of this disease, as well as of the possibility of atypical presentation of the common classical causes of FUO.
Assuntos
Abscesso/diagnóstico , Países em Desenvolvimento , Endocardite Bacteriana Subaguda/diagnóstico , Febre de Causa Desconhecida/diagnóstico , Leishmaniose Visceral/diagnóstico , Neoplasias/diagnóstico , Polimialgia Reumática/diagnóstico , Doença de Still de Início Tardio/diagnóstico , Infecções Urinárias/diagnóstico , Abscesso/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Endocardite Bacteriana Subaguda/complicações , Feminino , Febre de Causa Desconhecida/etiologia , Humanos , Leishmaniose Visceral/complicações , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Polimialgia Reumática/complicações , República da Macedônia do Norte , Estudos Retrospectivos , Doença de Still de Início Tardio/complicações , Infecções Urinárias/complicações , Adulto JovemAssuntos
Endocardite Bacteriana Subaguda/complicações , Glomerulonefrite/patologia , Rim/patologia , Complemento C3/metabolismo , Glomerulonefrite/etiologia , Glomerulonefrite/metabolismo , Humanos , Imunoglobulina A/metabolismo , Imunoglobulina G/metabolismo , Imunoglobulina M/metabolismo , Rim/metabolismo , Rim/ultraestrutura , Microscopia , Microscopia Eletrônica , Microscopia de FluorescênciaRESUMO
Pyomyositis is a pyogenic infection of the skeletal muscles causing myalgia and fever in patients. Hematogenous seeding engendered by persistent bacteremia and septic embolism is usually the underlying cause of the disease. Trauma, intravenous drug use, and immunodeficiency are the main predisposing factors.Obturator internus pyomyositis with sciatica has not previously been reported. We report a rare case of a patient with subacute bacterial endocarditis presenting with left buttock pain and sciatica.Computed tomography confirmed the diagnosis of obturator internus pyomyositis. The patient was discharged uneventfully after successful antibiotic treatment.The mortality rate of patients who have pyomyositis comorbid with another condition or disease is extremely high. Early diagnosis and aggressive management are imperative.