Liu Yan, Wang Xiaoming, Wang Zhibin, Zhu Yongsheng, Zhang Liying, Li Xiaoli, Xu Rong, Ge Wei
Department of Geriatrics, Xijing Hospital, Fourth Military Medical University, Changle West Road #127, Xi'an, Shaanxi Province, 710032, People's Republic of China.
Department of ultrasound diagnosis, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, 710032, People's Republic of China.
BMC Infect Dis. 2017 Jan 6;17(1):38. doi: 10.1186/s12879-016-2168-9.
The clinical features of bacteria endocarditis became atypical when consolidated with other conditions such as tuberculosis (TB). Especially, the symptoms of bacteria endocarditis (BE) which were hidden behind the TB fever often lead to misdiagnosis and missed diagnosis.
A 56-year-old male with thoracic vertebra bone TB history presented with low-grade fever, shortness of breath and cardiac souffle. After conventional antibiotic therapy and strengthen anti-tuberculosis treatment condition did not be improved. Further inspection, there were bacteria endocarditis with the vegetation across the mitral valve. But the other valves were not involved. He was treated with intravenous penicillin for 4 weeks in all including during surgery, and following with oral antibiotic for another 2 weeks. The patient improved clinically eventually.
It is the first reported case of isolated thoracic vertebra tuberculosis with valve endocarditis caused by streptococcus viridans and was successfully managed by combination therapy of internal medicine and surgery. It was suggested in tuberculosis patients, the possibility of bacterial endocarditis should be considered when came into fever and unexplained cardiac soufflé (in tuberculosis patients).
当合并其他疾病如结核病（TB）时，细菌性心内膜炎的临床特征变得不典型。特别是，隐藏在结核热背后的细菌性心内膜炎（BE）症状常常导致误诊和漏诊。
一名有胸椎骨结核病史的56岁男性，出现低热、呼吸急促和心杂音。经过常规抗生素治疗和强化抗结核治疗后病情未改善。进一步检查发现，二尖瓣有赘生物的细菌性心内膜炎，但其他瓣膜未受累。他总共接受了4周的静脉注射青霉素治疗，包括手术期间，随后又口服抗生素治疗2周。患者最终临床症状改善。
这是首例由草绿色链球菌引起的孤立性胸椎结核合并瓣膜性心内膜炎的病例，并通过内科和外科联合治疗成功治愈。建议在结核病患者中，出现发热和不明原因的心杂音（在结核病患者中）时应考虑细菌性心内膜炎的可能性。
