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感染性心内膜炎合并葡萄膜炎:1例罕见病例报告

Infective endocarditis with uveitis: a rare case report.

作者信息

Lee Hsiang-Chun, Lai Yi-Hon, Tsai Chih-Lee, Yen Jeng-Hsien, Lin Tsung-Hsien, Lai Wen-Ter, Sheu Sheng-Hsiung

机构信息

Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.

出版信息

Kaohsiung J Med Sci. 2007 Jan;23(1):40-4. doi: 10.1016/S1607-551X(09)70373-0.

Abstract

We report a case of a 51-year-old diabetic male who presented with a complaint of intermittent chills and fever that he had experienced for 10 days. No obvious respiratory tract, genitourinary tract, gastrointestinal tract, or skin lesions were observed. Blood culture data were positive for group B beta-streptococcus. Transthoracic and transesophageal echocardiography revealed vegetation in the anterior leaflet of the mitral valve. The patient was diagnosed with infective endocarditis (IE) and prescribed a parenteral antibiotic. Three days after admission, the patient complained of progressively blurred vision. Slit lamp examination found fine keratic precipitates and aqueous cells in the anterior chambers in both eyes, implying that the patient had uveitis. He was then prescribed a topical steroid for 4 months, and his vision improved gradually. This case is an important reminder that uveitis, not only endophthalmitis, can occur with IE. Treatment for one condition, if misapplied, may worsen the other.

摘要

我们报告一例51岁的糖尿病男性患者,他主诉间歇性寒战和发热已持续10天。未观察到明显的呼吸道、泌尿生殖道、胃肠道或皮肤病变。血培养数据显示B组β溶血性链球菌呈阳性。经胸和经食管超声心动图显示二尖瓣前叶有赘生物。该患者被诊断为感染性心内膜炎(IE),并给予肠外抗生素治疗。入院三天后,患者主诉视力逐渐模糊。裂隙灯检查发现双眼前房有细小的角膜后沉着物和房水细胞,这意味着患者患有葡萄膜炎。随后给他开了4个月的局部类固醇药物,其视力逐渐改善。该病例重要地提醒我们,IE不仅可并发眼内炎,还可并发葡萄膜炎。对一种病症的治疗若应用不当,可能会使另一种病症恶化。

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本文引用的文献

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Group B streptococcus endocarditis with endophthalmitis.
Mayo Clin Proc. 2005 Jan;80(1):74. doi: 10.1016/S0025-6196(11)62961-3.
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Management of uveitis.葡萄膜炎的管理
Clin Exp Med. 2004 Sep;4(1):21-9. doi: 10.1007/s10238-004-0034-3.
5
Diagnosis of infective endocarditis.感染性心内膜炎的诊断
BMJ. 2002 Oct 19;325(7369):845-6. doi: 10.1136/bmj.325.7369.845.
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Poststreptococcal reactive arthritis in adults: a case series.
Mayo Clin Proc. 2000 Feb;75(2):144-7. doi: 10.4065/75.2.144.

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