Fink Douglas, Frigiola Alessandra, Cullen Shay
Infection and Immunity, Royal Free London NHS Foundation Trust, London, UK.
BMJ Case Rep. 2012 Dec 19;2012:bcr2012007761. doi: 10.1136/bcr-2012-007761.
A 26-year-old woman presented moribund with fever and pleuritic chest pain 3 times in 4 months following elective aortic root surgery. She was admitted 41 days after surgery with cardiac tamponade requiring surgical drainage twice within 1 week. Despite this, she was re-admitted for a second time 4 days after discharge with persistent pericardial effusion. High fevers and an incidental regurgitant murmur were extensively investigated for and treated as possible endocarditis or graft infection without conclusive results. The patient spent a total of 61 days in hospital during this period, receiving seven different antibiotic courses. Her third admission, with most severe clinical features, nearly led to further surgery and removal of her aortic graft but instead culminated in a multidisciplinary team decision to initiate steroid therapy for postcardiotomy syndrome. A short course of oral prednisolone saw her pericardial effusion and symptoms resolve completely.
一名26岁女性在择期主动脉根部手术后4个月内3次因病情危重伴发热和胸膜炎性胸痛就诊。术后41天，她因心脏压塞入院，1周内需要进行两次外科引流。尽管如此，出院4天后她再次入院，存在持续性心包积液。针对高热和偶然出现的反流性杂音，对可能的感染性心内膜炎或移植物感染进行了广泛检查和治疗，但未得出明确结果。在此期间，该患者共住院61天，接受了七种不同的抗生素疗程。她第三次入院时临床症状最为严重，几乎导致进一步手术并移除主动脉移植物，但最终多学科团队决定启动针对心脏术后综合征的类固醇治疗。短期口服泼尼松龙后，她的心包积液和症状完全消失。
