Endocarditis lenta-patient survived septic shock: a case report

Amra Macić Džanković,Nina Burina,Snježana Mehanić,Mehmed Kulić

doi:10.17532/jhsci.2012.55

Abstract

Infective endocarditis is defi ned as an infection of the endocardial surface of the heart. Its intracardiac effects include severe valvular insuffi ciency, which may lead to intractable congestive heart failure and myocardialabscesses. This disease still carries a poor prognosis and a high mortality.A severe case of infective endocarditis with its complications is presented. A man with aortic prosthetic valve due to earlier aortic stenosis and corrected aortal coarctation and implanted pacemaker presentedwith prolonged unexplained fever, malaise, sweating, weight loss (15 kg/4 months) and lumbar pain. He was treated with broad-spectrum antibiotics prior IE diagnosis was considered. Echocardiogram showedaortic vegetations and possible periaortal abscess formation. Nonspecifi c infl ammation parameters were high positive. Cultures were constantly negative. His condition had deteriorated suddenly, and he had presentedwith worsening of cutaneous vasculitis, subacute glomerulonephritis and subsequent acute respiratory distress syndrome and septic shock. This patient survived with residual bilateral necrosis of the feet andtoxic peroneal paresis. At the end transthoracic echocardiogram showed enlarged heart chambers, LV mild dilated and concentric hypertrophy with ejection fraction about 40%, degenerative postinfl ammatory mitralvalve changes, mild mitral regurgitation and tricuspid regurgitation, postinfl ammatory aortic root fi brosis and moderate aortic valve stenosis (AVPG max 50,9 mmHg, AVPG mean 24 mmHg) with no pericardial effusion. Initial suspicion of Q fever was defi nitely excluded by serological testing showing nonspecifi c IgM positivity,probably rheumatoid factor related.

Highlights

Infective endocarditis (IE) is an interesting disease because of its constant incidence and mortality rate despite advances in both diagnostic and therapeutic procedures
We presented a case of culture-negative IE with multiple episodes of recurrent fever, vegetation formation on the prosthetic aortic valve, thromboembolic incidents through the whole body and subsequent complication development
The presented case of a prolonged, initialy unexplained febrile state was treated with broad-spectrum anibiotics without previously taking the appropriate samples for cultures that reduced the chances of identifying causative microorganism

Summary

Introduction

Infective endocarditis (IE) is an interesting disease because of its constant incidence and mortality rate despite advances in both diagnostic and therapeutic procedures. Case report In November 2011 a 51-year-old man was admitted to General Hospital Sarajevo because of high fever, sweating, high erythrocyte sedimentation rate and back pain. Three months prior to admission he has started complaining of pain around inferior scapula angle, profuse night sweats and prolonged fever ( about 38°C) and has lost weight (15 kg during this time). He was given paracetamol and antibiotics (he is allergic to penicillin). On admission to hospital he had no significant symptoms and fever was not documented He had normal hemodynamics and had no peripheral or renal signs of systemic infection.

Discussion

Conclusion