Shahani Lokesh
Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois, United States.
BMJ Case Rep. 2011 Nov 8;2011:bcr0720114538. doi: 10.1136/bcr.07.2011.4538.
Infective endocarditis remains a diagnostic and therapeutic challenge. The authors report an older male who presented with a lower extremities rash and signs of cardiac failure. Echocardiography showed vegetations attached to the bio-prosthetic aortic valve, however, with negative blood cultures. Further investigation revealed positive Bartonella serologies. The patient was diagnosed with Bartonella endocarditis affecting the prosthetic valve and started on appropriate antibiotics. Valvular surgery was refused by patient secondary to age and medical co-morbidities. The patient presented 10 days later with intracerebral haemorrhage and progression of the endocarditis as demonstrated on echocardiogram. Valve replacement was contraindicated at this occasion due to the intracerebral bleed. The patient had poor prognosis and a decision to withdraw care was made by the family. The authors demonstrate a case of complicated infective endocarditis caused by Bartonella species leading to multisystem involvement. This case highlights the need for urgent valve replacement in the setting of Bartonella endocarditis.
感染性心内膜炎仍然是一个诊断和治疗难题。作者报告了一名老年男性，他出现下肢皮疹和心力衰竭体征。超声心动图显示生物人工主动脉瓣上有赘生物，但血培养结果为阴性。进一步检查发现巴尔通体血清学检查呈阳性。该患者被诊断为感染人工瓣膜的巴尔通体心内膜炎，并开始使用适当的抗生素治疗。由于年龄和合并症，患者拒绝了瓣膜手术。10天后，患者出现脑出血，超声心动图显示心内膜炎进展。由于脑出血，此时瓣膜置换术被视为禁忌。患者预后较差，家属决定放弃治疗。作者展示了一例由巴尔通体引起的复杂性感染性心内膜炎病例，该病例导致多系统受累。该病例强调了在巴尔通体心内膜炎情况下紧急进行瓣膜置换的必要性。
