Tanaka Satoshi, Ohkado A, Yamada A, Inoue K, Wakita N
Department of Cardiovascular Surgery, Kobe Rosai Hospital, Kobe, Japan.
Kyobu Geka. 2008 Jun;61(6):470-3.
Infective endocarditis (IE) associated with vertebral osteomyelitis (VO) is relatively rare, but needs long and careful therapy. We report a case of the patient who was incidentally diagnosed as having IE during therapy for VO. A 77-year-old man was hospitalized with a complaint of high fever and back pain. Because magnetic resonance imaging demonstrated osteomyelitis, antibiotic therapy was started. Persistent infectious signs and congestive heart failure indicated the diagnosis of infective endocarditis. Echocardiogram demonstrated sever mitral regurgitation due to perforation of anterior mitral leaflet but no vegetation. Surgery revealed perforation of the valvular aneurysm of the anterior mitral leaflet, which was successfully repaired with deberidement and patch closure. Antibiotic therapy was continued for 4 months postoperatively. In the case of VO, it is often necessary to consider an association of IE, although it is hardly possible to determine which the preceding infection is.
感染性心内膜炎（IE）合并脊椎骨髓炎（VO）相对少见，但需要长期且精心的治疗。我们报告一例在治疗VO期间偶然诊断为IE的患者。一名77岁男性因高热和背痛入院。由于磁共振成像显示骨髓炎，遂开始抗生素治疗。持续的感染征象和充血性心力衰竭提示感染性心内膜炎的诊断。超声心动图显示二尖瓣前叶穿孔导致严重二尖瓣反流，但未见赘生物。手术发现二尖瓣前叶瓣膜瘤穿孔，经清创和补片修补成功修复。术后继续抗生素治疗4个月。对于VO病例，尽管很难确定哪个是先前的感染，但通常有必要考虑合并IE。
