Ohshima H, Itaoka Y, Ohno M, Hara K, Kashida M, Kuwako K, Yamaguchi T
Center for Cardiovascular Disease, Mitsui Memorial Hospital.
Kokyu To Junkan. 1990 Mar;38(3):277-81.
A 49-year-old man was admitted to Mitsui Memorial Hospital because of fever of unknown origin. Since one year ago, he had often used intravenous narcotic drugs. Ten months before his admission, he had his first experience of fever and a chill. Four months later, he was admitted to a hospital under the diagnosis of pneumonia and he was treated successfully. After his discharge, he began to use drugs again, which resulted in the repetition of fever and chills during four months prior to his admission to our hospital. On admission, physical findings concerning the patient were unremarkable, except for mild hepatomegaly. ECG and chest X-ray were normal. Laboratory data revealed marked inflammatory changes and severe liver injury. Blood culture disclosed Campylobacter fetus and two dimensional echocardiography showed a large vegetation on the anterior tricuspid valve. He was diagnosed as isolated tricuspid infective endocarditis accompanied with acute hepatitis due to drug abuse. Moreover pulmonary perfusion scintigraphy showed decreased perfusion in the right lower lung field, which suggested that pneumonia of six months ago was due to septic pulmonary emboli from the infected tricuspid valve. The combined antibiotics therapy was successful. By the follow-up echocardiographic studies, the size of vegetation was observed to decrease progressively.
一名49岁男性因不明原因发热入住三井纪念医院。自一年前起，他经常使用静脉注射麻醉药品。入院前十个月，他首次出现发热和寒战。四个月后，他因肺炎诊断入住一家医院并得到成功治疗。出院后，他又开始吸毒，导致在入住我院前四个月反复出现发热和寒战。入院时，除轻度肝肿大外，患者的体格检查结果无明显异常。心电图和胸部X线检查正常。实验室数据显示有明显的炎症变化和严重的肝损伤。血培养发现胎儿弯曲杆菌，二维超声心动图显示三尖瓣前叶有一个大的赘生物。他被诊断为因药物滥用导致的孤立性三尖瓣感染性心内膜炎伴急性肝炎。此外，肺灌注闪烁显像显示右下肺野灌注减少，提示六个月前的肺炎是由感染的三尖瓣引起的脓毒性肺栓塞所致。联合抗生素治疗取得成功。通过超声心动图随访研究，观察到赘生物的大小逐渐减小。
