Subacute streptococcus viridans endarteritis superimposed on patent ductus arteriosus: Spontaneous recovery. Recurrence after twelve and one-half years. Recovery following operative treatment

Abstract

A 51-year-old female with patent ductus arteriosus, suffered an episode of subacute Streptococcus viridans endarteritis twelve and one-half years previously. At the time, the diagnosis of a congenital cardiac lesion was based upon the absence of a history of rheumatic fever and the presence of a characteristic murmur, known to be of long duration. The diagnosis of superimposed infection rested upon the presence of irregular fever, chills, malaise, splenic enlargement, petechiae, and several episodes of pulmonary infarction, and was confirmed by blood cultures which repeatedly were positive for Streptococcus viridans. The treatment consisted of repeated blood transfusions, supportive therapy, and injections of an autogenous vaccine. After an illness of approximately fifteen months, she apparently recovered completely. The patient first came under the observation of one of the authors, with symptoms of mild circulatory failure, approximately eight years prior to the present admission. During the ensuing years the circulatory symptoms increased slowly but progressively. Approximately four and one-half weeks before admission to the hospital, clinical manifestations of superimposed infection, similar to those present twelve and one-half years previously, reappeared. During a twenty-three-day period of hospital observation, the clinical course was progressively downhill. The administration of both sulfapyridine and sulfathiazole was without sgnificant effect; and blood cultures revealed as many as fifty-two colonies of Streptococcus viridans per cubic centimeter. Operation was performed primarily for the purpose of eliminating the infection. The procedure consisted of double ligation of the ductus, by a modification of technique devised by one of the authors. A blood culture taken forty minutes after operation was sterile throughout fourteen days of incubation. Four blood cultures were taken subsequently, and these likewise were negative. Chemotherapy was not administered during the postoperative course. Approximately nine months have elapsed since operation. All manifestations of infection and of circulatory failure remain absent, and the patient is in better health than in many years. This is the first case of spontaneous recovery from subacute Streptococcus viridans infection superimposed upon a proved patent ductus arteriosus. It also is the first case of infected patent ductus in which, after recovery from an initial episode, the infection recurred. Finally, it is our third, in which operation upon a patent ductus arteriosus has been followed by recovery from infection.