Rahmati Elham, Jan Geiseler P, She Rosemary C
Department of Medicine, Division of Infectious Diseases, Keck School of Medicine of the USC- LAC, Los Angeles, USA.
Department of Pathology, Keck School of Medicine of the University of Southern California, Los Angeles, USA.
JMM Case Rep. 2017 May 9;4(5):e005095. doi: 10.1099/jmmcr.0.005095. eCollection 2017 May.
is a rare etiology of infectious endocarditis with only 30 cases of prosthetic valve and about twice as many native valve infections described in the literature. We describe an unusual presentation of an endovascular embolic phenomenon with associated lower extremity mycotic aneurysm due to prosthetic aortic valve and aortic endograft infection. This is a case of an elderly gentleman with prior history of bioprosthetic aortic valve placement and aortic arch repair who was admitted with several weeks of constitutional symptoms and left lower leg pain. Diagnostic work-up was consistent with thrombosed popliteal artery aneurysm. Blood cultures were positive for . A transesophageal echocardiogram revealed vegetation on the bioprosthetic valve. The patient underwent arterial bypass and ligation of the aneurysm as well as redoing of his aortic valve and aortic graft replacement. Histopathology of the aortic valve was remarkable for acute inflammation and Gram-positive coccobacilli and bacilli occupying intracellular spaces. The results of broad-range bacterial 16S rRNA PCR and sequence analysis of unfixed aortic valve tissue confirmed detection of . Infective endocarditis attributable to species of the genus is a rare entity. As such, there are no specific guidelines for treatment of endocarditis. However, combination of penicillin or ampicillin with gentamicin is the most acceptable approach described in the literature. Our patient was treated with ampicillin and gentamicin for 6 weeks followed by life-long amoxicillin suppression therapy. The patient remained asymptomatic at a 6 months follow up visit.
是感染性心内膜炎的一种罕见病因，文献中仅描述了30例人工瓣膜感染病例，天然瓣膜感染病例约为其两倍。我们描述了一例因人工主动脉瓣和主动脉内移植物感染导致的伴有下肢真菌性动脉瘤的血管内栓塞现象的不寻常表现。这是一例老年男性患者，既往有生物人工主动脉瓣置换和主动脉弓修复病史，因数周的全身症状和左小腿疼痛入院。诊断检查结果与腘动脉血栓形成性动脉瘤一致。血培养结果为阳性。经食管超声心动图显示生物人工瓣膜上有赘生物。患者接受了动脉搭桥和动脉瘤结扎术，以及主动脉瓣和主动脉移植物置换术的再次手术。主动脉瓣的组织病理学表现为急性炎症，革兰氏阳性球菌和杆菌占据细胞内空间。未固定的主动脉瓣组织的广谱细菌16S rRNA PCR和序列分析结果证实检测到了。由该属菌种引起的感染性心内膜炎是一种罕见疾病。因此，对于心内膜炎的治疗没有具体的指南。然而，青霉素或氨苄西林与庆大霉素联合使用是文献中描述的最可接受的方法。我们的患者接受了氨苄西林和庆大霉素治疗6周，随后进行终身阿莫西林抑制治疗。在6个月的随访中，患者仍无症状。
