Chesdachai Supavit, Larbcharoensub Noppadol, Chansoon Tharintorn, Chalermsanyakorn Panas, Santanirand Pitak, Chotiprasitsakul Darunee, Ratanakorn Disya, Boonbaichaiyapruck Sarana
Southeast Asian J Trop Med Public Health. 2014 Jan;45(1):142-8.
We report the case of a 64-year-old man with Arcanobacterium pyogenes endocarditis. The patient presented with dyspnea and asymmetrical progressive quadriparesis. A transthoracic echocardiogram revealed mobile vegetations on both leaflets of his mitral valve measuring 0.5 x 3 cm, thickening of the mitral valve with severe mitral regurgitation due to dehiscence of the papillary muscle to the posterior mitral leaflet. He also had aortic sclerosis with a vegetation measuring 0.5 x 1 cm causing aortic valve dehiscence and free flow aortic regurgitation. An initial hemoculture grew out pleomorphic, gram-positive, non-motile, anaerobic to microaerophilic bacilli. A diagnosis of infective endocarditis was made using modified Duke criteria. He was treated with intravenous ampicillin and gentamicin. Four days after admission, he developed acute respiratory failure and succumbed to the disease. A pre-mortem hemoculture and post-mortem heart valve culture grew Arcanobacterium pyogenes. Septic thromboemboli involving the brain, kidneys, lungs and spleen were documented. The patient also had ischemic vasculopathy with focal spinal arteriolitis and bilateral demyelination of the cervical corticospinal tracts. There are three published reports of human A. pyogenes endocarditis in the literature. Neurological involvement with ischemic spinal vasculopathy and demyelination has not been reported. We report the first autopsy proven case of A. pyogenes infective endocarditis with ischemic spinal vasculopathy. We review the clinicopathologic features of systemic A. pyogenes infection.
我们报告一例64岁男性化脓隐秘杆菌性心内膜炎病例。患者表现为呼吸困难和不对称性进行性四肢瘫。经胸超声心动图显示其二尖瓣两个瓣叶上有活动的赘生物，大小为0.5×3厘米，二尖瓣增厚，因乳头肌与二尖瓣后叶裂开导致严重二尖瓣反流。他还患有主动脉硬化，有一个大小为0.5×1厘米的赘生物，导致主动脉瓣裂开和主动脉瓣反流。初次血培养长出多形性、革兰氏阳性、不运动、厌氧至微需氧的杆菌。根据改良的杜克标准诊断为感染性心内膜炎。给予静脉注射氨苄西林和庆大霉素治疗。入院四天后，他出现急性呼吸衰竭并死于该病。生前血培养和死后心脏瓣膜培养均培养出化脓隐秘杆菌。记录到有累及脑、肾、肺和脾的感染性血栓栓塞。患者还患有缺血性血管病，伴有局灶性脊髓小动脉炎和双侧颈皮质脊髓束脱髓鞘。文献中有三篇关于人类化脓隐秘杆菌性心内膜炎的报道。尚未有神经受累伴缺血性脊髓血管病和脱髓鞘的报道。我们报告首例经尸检证实的化脓隐秘杆菌感染性心内膜炎伴缺血性脊髓血管病病例。我们回顾系统性化脓隐秘杆菌感染的临床病理特征。
