A Case Report of Fever and Severe Anemia Caused by Repeated Epistaxis

Abstract

Objective: To explore the potential pathogenicity of epistaxis in routine diagnosis and treatment. Methods: The data of a patient with recurrent epistaxis and fever for more than 5 months were observed. Li Mou, a 21-year-old male patient complained epistaxis after digging his nose and was relieved after self-packing treatment before May. Due to the habit of blowing nose, digging his nose and staying up late in nights for playing games, he did not paid attention to his recurrent epistaxis 3 ~ 5 times a month. He had fever in January and his blood routine examination showed mild anemia. Autoimmune hemolytic anemia was considered after screening for blood system disorders. There was no remission after shock treatment with prednisone tablets, and the degree of anemia increased gradually. Frequent epistaxis did not improve after repeated nasal endoscopy, tamponade, cauterization and other treatment. He was admitted to hospital with severe anemia. After admission, the patient was examined for anemia, pale eyelid and conjunctiva, and it was fixed with oil gauze in both nasal cavities. A systolic murmur was heard in the apical region and the second auscultation area of aortic valve; the respiratory sounds of both lungs were rough, and there were no dry and wet rales. The abdomen was soft, without tenderness, rebound pain and muscle tension; there was no edema in both lower limbs. Two independent blood cultures were examined after admission, which showed defective hypoxic bacteria. Cardiac color Doppler ultrasound showed valve vegetations, perforation and reflux. Diagnosis of infective endocarditis caused by defective hypoxic bacteria was made after examination. Antibiotics combined with valve replacement surgery were performed for the treatment. Results: After one year follow-up, the symptoms of anemia and epistaxis were reveled. Conclusion: Routine diagnosis and treatment of epistaxis may be a potential risk factor for infective endocarditis; the presence of infective endocarditis and bacteremia may increase the frequency of epistaxis, resulting in multiple visits to hospital for treatment of epistaxis; in the diagnosis and treatment of autoimmune hemolytic anemia, it is necessary to screen infective endocarditis to rule out the adequate diagnosis.