Yamashita Shun, Tago Masaki, Katsuki Naoko E, Ajimi Tsuneki, Nagatomo Daisuke, Kotooka Norihiko, Node Koichi, Yamashita Shu-Ichi
Department of General Medicine, Saga University Hospital, Saga City, Saga, Japan.
Department of Cardiovascular Medicine, Saga University, Saga City, Saga, Japan.
Am J Case Rep. 2018 Dec 11;19:1467-1473. doi: 10.12659/AJCR.912097.
BACKGROUND Infective endocarditis is prevalent worldwide and the modified Duke criteria have been used universally to diagnose this condition. However, making the correct diagnosis is rather difficult because the clinical presentation and findings of blood tests are non-specific. CASE REPORT A 70-year-old female complaining of dyspnea for 5 days with acute mitral regurgitation was transferred to our hospital. She had acute heart and respiratory failure and disseminated intravascular coagulation. Although infective endocarditis was suspected, repeated blood cultures and transesophageal echocardiography could not reveal any findings of infective endocarditis. Because the etiology of her condition was not determined by various examinations, mitral annuloplasty was required to treat her mitral regurgitation, and was performed for definitive diagnosis and treatment revealing the presence of vegetation on the mitral valve. Enterococcus faecalis was detected by cultures of the mitral valve and blood after the surgery. CONCLUSIONS It can be very difficult to diagnose infective endocarditis correctly, especially when a case fails to fulfill the modified Duke criteria. In such a case, only cardiac surgery might enable us to make an accurate diagnosis and save a patient's life.
感染性心内膜炎在全球范围内普遍存在，改良的杜克标准已被广泛用于诊断该病。然而，由于临床表现和血液检查结果缺乏特异性，做出正确诊断相当困难。病例报告：一名70岁女性因急性二尖瓣反流伴呼吸困难5天被转入我院。她患有急性心功能和呼吸功能衰竭以及弥散性血管内凝血。尽管怀疑患有感染性心内膜炎，但反复的血培养和经食管超声心动图检查均未发现感染性心内膜炎的任何迹象。由于通过各种检查未能确定其病情的病因，因此需要进行二尖瓣环成形术来治疗二尖瓣反流，并进行该手术以明确诊断和治疗，结果发现二尖瓣上存在赘生物。术后二尖瓣和血液培养检测到粪肠球菌。结论：正确诊断感染性心内膜炎可能非常困难，尤其是当病例不符合改良的杜克标准时。在这种情况下，只有心脏手术可能使我们能够做出准确诊断并挽救患者生命。
