Tanioka Hideki, Iwata Keiji, Marumoto Akira, Kaneko Mitsunori
Department of Cardiovascular Surgery, National Osaka Minami Medical Center, Kawachinagano, Japan.
Kyobu Geka. 2015 May;68(5):383-6.
A 26-year-old man had a history of severe atopic dermatitis. He was taking immunosuppressive drug. Mitral valve replacement (MVR) had been performed for infective endocarditis March 2008. He came to our hospital in July 2012 complaining of fever of 39 degrees Celsius. According to computed tomography (CT) and transesophageal echocardiography (TEE), we diagnosed that he had cerebral embolism and bacterial infection of prosthetic valve. Antibiotic treatment was performed for 2 weeks after the onset of cerebral infarction. Then we conducted re-MVR. The postoperative course was satisfactory. He showed a gradual improvement in the level of consciousness and was discharged. In patients with atopic dermatitis, bacteria can penetrate into the blood from the skin easily. So they are often affected by bacteremia. There are some reports that infective endocarditis is likely to occur in immunosuppressed patients. It is suggested that immunosuppressive drug was involved in the development of prosthetic valve endocarditis (PVE) in addition to atopic dermatitis in this patient.
一名26岁男性有严重特应性皮炎病史。他正在服用免疫抑制药物。2008年3月因感染性心内膜炎接受了二尖瓣置换术（MVR）。2012年7月，他因发热至39摄氏度前来我院就诊。根据计算机断层扫描（CT）和经食管超声心动图（TEE）检查，我们诊断他患有脑栓塞和人工瓣膜细菌感染。脑梗死发病后进行了2周的抗生素治疗。然后我们进行了再次二尖瓣置换术。术后过程顺利。他的意识水平逐渐改善并出院。在特应性皮炎患者中，细菌很容易从皮肤侵入血液。所以他们经常受到菌血症的影响。有一些报道称免疫抑制患者容易发生感染性心内膜炎。提示该患者除特应性皮炎外，免疫抑制药物也参与了人工瓣膜心内膜炎（PVE）的发生。
