Abstract
Introduction-Atopic dermatitis (AD) is a common condition in the United Kingdom with the prevalence varying from 21% in infants aged 0–6 months to 6.4% at the age of 16 years. Patients with AD experience high rates of colonization of their skin surfaces by Staphylococcus aureus (S. aureus). In severe AD there is a potential risk of staphylococcal bacteremia and invasive infection such as acute endocarditis.Case presentation-We report a case of acute endocarditis with mitral valve destruction caused by S. aureus in a 30-year-old man with severe AD. The patient received intensive inpatient treatment with antibiotics and underwent successful mitral valve replacement and skin treatment for AD.Conclusion-Patients with severe AD are at higher risk of staphylococcal bacteremia and endocarditis. Staphylococcal endocarditis has to be considered in the differential diagnosis of febrile illness in patients with uncontrolled atopic dermatitis.
Highlights
Atopic dermatitis (AD) is a common condition in the United Kingdom with the prevalence varying from 21% in infants aged 0–6 months to 6.4% at the age of 16 years
Conclusion-: Patients with severe AD are at higher risk of staphylococcal bacteremia and endocarditis
Staphylococcal endocarditis has to be considered in the differential diagnosis of febrile illness in patients with uncontrolled atopic dermatitis
Summary
AD is a common skin disorder where there is excessive formation of IgE antibodies to inhaled, injected or ingested allergen. A 30-year-old man with history of AD presented to the accident and emergency department of our hospital with fever and generalized skin rash. He complained of malaise and poor appetite for a week. Blood culture at that time showed no growth but his central venous line tip grew a coagulasenegative staphylococcus sensitive to rifampicin, vancomycin and netilmycin. He underwent transoesophageal echocardiogram which showed perforation of the posterior mitral cusp with significant mitral regurgitation (Figure 2) He underwent successful mitral valve replacement 5 months following the presenting episode of infective endocarditis and was commenced on warfarin. Though he had an episode of eczema herpeticum two years following the infective endocarditis, he continues to do well
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