Abukar Amin Abdurahman, Michail Michael, Smith Maurice A, Wickramasinghe Liyanagae S P
Department of Acute Elderly Care, Queen's Hospital, Romford, UK.
Department of Cardiology, Queen's Hospital, London, UK.
BMJ Case Rep. 2015 Mar 27;2015:bcr2014208212. doi: 10.1136/bcr-2014-208212.
A 77-year-old woman presented to the emergency department with a 1-week history of anorexia, fatigue, general malaise and a 3-day history of fever. Clinical examination revealed livedo reticularis across the anterior aspect of her knees and a pansystolic murmur. Laboratory evaluation found neutrophil leucocytosis; elevated C reactive protein and blood cultures grew Streptococcus acidominimus. Transthoracic echocardiography displayed vegetation on the mitral valve and a left atrial myxoma. She was treated with intravenous benzylpenicillin and erythromycin for the infective endocarditis (IE) and remains well 3 months post-treatment. S. acidominimus is considered a common veterinary pathogen rarely found in humans. To the best of our knowledge, only two prior reports of IE due to this organism exist in the literature. This case highlights how rare pathogens can cause unusual presentation and the importance of IE as a differential even in the absence of classical signs, if fever and new murmur are present.
一名77岁女性因厌食、疲劳、全身不适1周及发热3天就诊于急诊科。临床检查发现其双膝关节前部有网状青斑及全收缩期杂音。实验室检查发现中性粒细胞增多、C反应蛋白升高，血培养生长出嗜酸微球菌。经胸超声心动图显示二尖瓣有赘生物及左房黏液瘤。她因感染性心内膜炎接受了静脉注射苄星青霉素和红霉素治疗，治疗后3个月情况良好。嗜酸微球菌被认为是一种常见的兽医病原体，在人类中很少发现。据我们所知，文献中仅有两篇此前关于该病原体所致感染性心内膜炎的报告。该病例突出了罕见病原体可导致不寻常表现，以及即使在无典型体征但存在发热和新出现杂音时，将感染性心内膜炎作为鉴别诊断的重要性。
