Manade Vivek Vilas, Kakrani Arjun, Gadage Siddharth Narayan, Misra Rabindra
Department of Medicine, Padmashree Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India.
Department of Microbiology, Padmashree Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India.
BMJ Case Rep. 2014 Sep 19;2014:bcr2014203555. doi: 10.1136/bcr-2014-203555.
A 67-year-old man with type 2 diabetes mellitus and hypertension since 7 years presented with a 3-month history of low-grade fever and malaise. Cardiac auscultation revealed the presence of an ejection systolic murmur in the primary aortic area. Most of the investigations for febrile illness were reported normal. His two-dimensional (2D) echocardiogram revealed a calcified aortic valve with mild aortic stenosis. In view of the prolonged fever and calcified aortic valve with mild aortic stenosis, a transoesophageal echocardiogram was performed, which showed small vegetation noted on right coronary cusp about 2.2 mm with free independent mobility. Blood culture was positive for Brucella spp from all the three venepuncture sites. Medical therapy for brucellosis was given with ciprofloxacin, doxycycline, co-trimoxazole and streptomycin, resulting in complete recovery. Brucella endocarditis is a rare, mostly ignored and missed clinical infection. It requires a high index of clinical suspicion for prompt diagnosis and treatment.
一名67岁男性，患2型糖尿病和高血压7年，出现低热和全身不适3个月。心脏听诊发现主动脉瓣区有喷射性收缩期杂音。大多数发热性疾病的检查结果均正常。他的二维超声心动图显示主动脉瓣钙化伴轻度主动脉瓣狭窄。鉴于长期发热以及钙化的主动脉瓣伴轻度主动脉瓣狭窄，进行了经食管超声心动图检查，结果显示右冠状动脉瓣叶上有一个约2.2毫米的小赘生物，具有自由独立的活动度。所有三个静脉穿刺部位的血培养布鲁氏菌属均呈阳性。给予环丙沙星、强力霉素、复方新诺明和链霉素进行布鲁氏菌病的药物治疗，患者完全康复。布鲁氏菌性心内膜炎是一种罕见的、大多被忽视和漏诊的临床感染。它需要高度的临床怀疑指数以便及时诊断和治疗。
