三尖瓣血培养阴性感染性心内膜炎的罕见并发症:病例报告。

IF 0.8 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS
European Heart Journal: Case Reports Pub Date : 2024-10-22 eCollection Date: 2024-11-01 DOI:10.1093/ehjcr/ytae570
Giovanni Bellina, Salvatore Scandura, Salvatore Lentini, Davide Capodanno, Corrado Tamburino
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引用次数: 0

摘要

背景:心内膜炎是一种传染性疾病,发病率为每 10 万人中 15 例,10% 的病例会影响三尖瓣。血液培养阴性的感染性心内膜炎(BCNIE)占感染性心内膜炎病例的 20% 以上。感染向瓣周扩展是 BCNIE 最有害的并发症。病例摘要:一名 25 岁的南亚男性因发热 15 天和新发胸痛入院。血液检查显示炎症指数升高。胸部 X 光片显示心影增大。心脏检查时,在左胸骨边缘听到全收缩期杂音。经胸超声心动图显示,三尖瓣上有丝状物形成,主动脉和右心房之间有沟通,并伴有左-右分流。患者接受了经食道超声心动图(TEE)检查,确诊为 IE。进行了三组血培养,结果均为阴性,进行了经验性治疗,并决定在 TEE 引导下进行心脏手术:瘘管是一种罕见的 IE 并发症,是 BCNIE 等感染失控的最隐匿的后果,这种情况限制了治疗的可能性,只能采用经验疗法和早期手术。超声心动图有助于诊断右侧感染性心内膜炎,使我们能够关注瓣周感染的扩散情况。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A rare complication of blood culture-negative infective endocarditis on tricuspid valve: case report.

Background: Endocarditis is an infectious disease, with an incidence of ∼15 cases per 100 000 people, affecting the tricuspid valve in 10% of cases. Infective endocarditis with negative blood cultures (BCNIE) accounts for more than 20% of cases of infective endocarditis. Perivalvular extension of the infection represents the most detrimental complications of BCNIE.

Case summary: A 25-year-old South Asian male was admitted due to fever for 15 days and new onset chest pain. The blood tests showed an increase in inflammatory indices. A chest X-ray showed enlargement of the cardiac shadow. On cardiac examination, a holosystolic murmur at the left sternal edge border was heard. The transthoracic echocardiogram showed a filamentous formation on the tricuspid valve and communication between the aorta and right atrium with left-right shunt. A transoesophageal echocardiogram (TEE) was performed to confirm the diagnosis of IE. Three sets of blood cultures were performed, with negative results, empirical therapy was managed and a decision for TEE-guided cardiac surgery was made.

Discussion: Fistula is a rare complication of IE representing the most insidious consequence of uncontrolled infection like BCNIE, a condition that has restricted the therapeutic possibilities to empirical therapy only and to early surgery. The TEE was instrumental in diagnosing right-sided infective endocarditis and allowing us to focus on the perivalvular spread of the infection in our case.

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来源期刊
European Heart Journal: Case Reports
European Heart Journal: Case Reports Medicine-Cardiology and Cardiovascular Medicine
CiteScore
1.30
自引率
10.00%
发文量
451
审稿时长
14 weeks
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