Internal Medicine Department, AP-HP, Hôpital Tenon, Paris, France.
Heart Lung. 2012 Nov-Dec;41(6):e21-3. doi: 10.1016/j.hrtlng.2012.04.006. Epub 2012 May 30.
A 74-year-old man, with a permanent pacemaker placed 2 years ago for high-grade atrioventricular block, was admitted for worsening fatigue, confusion, and thrombocytopenic purpura without fever. White blood cell count and C-reactive protein were elevated, and echocardiography revealed a 6 × 3-cm echogenic mass surrounding the pacemaker leads. Multiple blood cultures were performed, and only 1 bottle grew Propionibacterium acnes at 93 hours. The patient underwent surgery, and 16S rRNA gene polymerase chain reaction amplification confirmed the presence of P. acnes in the removed vegetation. Patients with late-onset, device-related endocarditis often present with vague symptoms and fever may be absent, obscuring the clinical diagnosis. Blood cultures and transesophageal echocardiography are key diagnostic tests. As a slow-growing, low virulent, and common human skin germ, P. acnes can be wrongly considered as a blood culture contaminant.
一位 74 岁男性，2 年前因高度房室传导阻滞植入永久性起搏器，因进行性疲劳、意识混乱和血小板减少性紫癜而入院，无发热。白细胞计数和 C 反应蛋白升高，超声心动图显示起搏器导线周围有一个 6×3cm 的高回声肿块。进行了多次血培养，只有 1 瓶在 93 小时后生长出痤疮丙酸杆菌。患者接受了手术，16S rRNA 基因聚合酶链反应扩增证实切除的赘生物中存在痤疮丙酸杆菌。迟发性、器械相关心内膜炎患者常表现为症状不明确，且可能无发热，从而使临床诊断变得复杂。血培养和经食管超声心动图是关键的诊断性检查。作为一种生长缓慢、毒力较低且常见的人类皮肤细菌，痤疮丙酸杆菌可能会被错误地认为是血培养的污染菌。
