Khafaga Mounir, Kresoja Karl-Patrik, Urlesberger Berndt, Knez Igor, Klaritsch Philipp, Lumenta David Benjamin, Krause Robert, von Lewinski Dirk
Department of Cardiology, Medical University of Graz, 8036 Graz, Austria.
Division of Neonatology, Department of Paediatrics, Medical University of Graz, 8036 Graz, Austria.
Case Rep Obstet Gynecol. 2016;2016:7030382. doi: 10.1155/2016/7030382. Epub 2016 Mar 9.
Background. Infective endocarditis is associated with considerable morbidity and mortality. Guidelines addressing prophylaxis and management of infective endocarditis do not extensively deal with concomitant pregnancy, and case reports on infective endocarditis are scarce. This is the first published report of infective endocarditis by Staphylococcus lugdunensis in a pregnant woman. Case Presentation. We report a single case of a 35-year-old woman in her 24th week of pregnancy who was admitted to our intensive care unit with fever and suspected infectious endocarditis. Blood culture detected Staphylococcus lugdunensis. A vegetation and severe mitral regurgitation due to complete destruction of the valve confirmed the diagnosis. An interdisciplinary panel of cardiologists, maternal-fetal medicine specialists, cardiac and plastic surgeons, infectiologists, anesthesiologists, and neonatologists was formed to determine the best therapeutic strategy. Conclusions. Timing and indications for surgical intervention to prevent embolic complications in infective endocarditis remain controversial. This original case report illustrates how managing infective endocarditis by Staphylococcus lugdunensis particularly in the 24th week of pregnancy can represent a therapeutic challenge to a broad section of specialties across medicine. Critical cases like this require a thorough weighing of risks and benefits followed by swift action to protect the mother and her unborn child.
背景。感染性心内膜炎与相当高的发病率和死亡率相关。针对感染性心内膜炎预防和管理的指南并未广泛涉及妊娠合并情况,且关于感染性心内膜炎的病例报告较少。这是首例关于一名孕妇感染路邓葡萄球菌性心内膜炎的发表报告。病例介绍。我们报告一例35岁女性,孕24周,因发热及疑似感染性心内膜炎入住我们的重症监护病房。血培养检测出路邓葡萄球菌。瓣膜完全破坏导致的赘生物及严重二尖瓣反流确诊了诊断。组建了一个跨学科专家小组,成员包括心脏病专家、母胎医学专家、心脏和整形外科医生、感染病专家、麻醉师和新生儿科医生,以确定最佳治疗策略。结论。感染性心内膜炎手术干预预防栓塞并发症的时机和指征仍存在争议。这例原始病例报告说明了如何处理路邓葡萄球菌性感染性心内膜炎,尤其是在妊娠24周时,对医学各专业来说可能是一个治疗挑战。像这样的危急病例需要全面权衡风险和益处,然后迅速采取行动保护母亲及其未出生的孩子。