Varona José F, Guerra Juan M
Departamento de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, Spain.
Rev Esp Cardiol. 2004 Oct;57(10):993-6.
Right-sided endocarditis is exceptional in non-drug addict patients without previous heart disease. Few cases have been published, and its diagnosis sometimes presents a significant clinical challenge. We describe a 57-year-old patient with no history of parenteral drug addiction or vascular catheter use, who had tricuspid valve endocarditis in a morphologically normal valve. The clinical debut was characterized by acute febrile syndrome, purpura (petechia) on the legs, and oligoarthritis. This entity usually has a good prognosis and responds well to treatment, and presents certain common clinical features (persistent fever, pulmonary lesions, anemia and microscopic hematuria) that can lead the clinician to suspect the diagnosis. However, diagnosis should be based on microbiological studies (S. aureus is the organism isolated most often) and on echocardiographic findings.
右侧心内膜炎在无既往心脏病史的非吸毒患者中较为罕见。已发表的病例很少，其诊断有时会带来重大的临床挑战。我们描述了一名57岁的患者，无静脉药物成瘾或血管导管使用史，其形态正常的瓣膜发生了三尖瓣心内膜炎。临床首发表现为急性发热综合征、腿部紫癜（瘀点）和少关节炎。该疾病通常预后良好，对治疗反应良好，并具有某些常见的临床特征（持续发热、肺部病变、贫血和镜下血尿），可使临床医生怀疑该诊断。然而，诊断应基于微生物学研究（最常分离出的病原体是金黄色葡萄球菌）和超声心动图检查结果。
