Katchi Tasleem, Cooper Howard A, Yandrapalli Srikanth S, Khera Sahil, Fallon John, Spielvogel David, Aronow Wilbert S, Panza Julio A
Department of Internal Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY, USA.
Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, USA. Electronic correspondence:
J Heart Valve Dis. 2017 May;26(3):365-367.
Despite significant technological advances, the diagnosis of infective endocarditis (IE) remains a major challenge, and the condition continues to be associated with significant morbidity and mortality. Valvular vegetations have long been the diagnostic and pathologic hallmarks of IE. However, IE can be diagnosed even in the absence of vegetations using the modified Duke criteria. Vegetation-negative endocarditis is rare, and to the present authors' knowledge no cases of septic emboli in the absence of valvular vegetations have been reported. Herein is reported a case of prosthetic aortic valve endocarditis associated with both clinical and radiologic evidence of septic emboli, but in the absence of vegetations on both repeated transesophageal echocardiography and pathologic evaluation. This case highlights the importance of maintaining a high clinical suspicion and a low threshold for the surgical replacement of a possibly infected valve, in patients that meet other clinical criteria for IE, even in the absence of detectable valvular vegetations.
尽管技术取得了重大进步，但感染性心内膜炎（IE）的诊断仍然是一项重大挑战，而且该病仍然与显著的发病率和死亡率相关。瓣膜赘生物长期以来一直是IE的诊断和病理标志。然而，使用改良的杜克标准，即使没有赘生物也可以诊断IE。无赘生物的心内膜炎很罕见，据本文作者所知，尚未有在没有瓣膜赘生物的情况下发生脓毒性栓子的病例报道。本文报告了一例人工主动脉瓣心内膜炎病例，该病例同时具有脓毒性栓子的临床和影像学证据，但在重复经食管超声心动图检查和病理评估中均未发现赘生物。该病例突出了对于符合IE其他临床标准的患者，即使没有可检测到的瓣膜赘生物，也需保持高度临床怀疑并降低对可能感染瓣膜进行手术置换的阈值的重要性。
