三尖瓣感染性心内膜炎合并多种病原体所致的多发性肺脓肿和胸腔积脓：一例报告
Tricuspid valve infective endocarditis complicated with multiple lung abscesses and thoracic empyema as different pathogens: a case report.
作者信息
Cheng Ya-Fu, Hsieh Yung-Kun, Wang Bing-Yen, Cheng Ching-Yugn, Huang Chang-Lun
机构信息
Division of general thoracic surgery, department of Surgery, Changhua Christian Hospital, No. 135 Nanxiao St., Changhua City, Changhua County, 500, Taiwan.
Division of cardiovascular surgery, department of surgery, Changhua Christian Hospital, Changhua, Taiwan.
出版信息
J Cardiothorac Surg. 2019 Feb 26;14(1):41. doi: 10.1186/s13019-019-0867-1.
BACKGROUND
Only 4.1% of tricuspid valve IE cases require surgical intervention. The complication after tricuspid valve IE with lung abscess and empyema is rare.
CASE PRESENTATION
We report the case of a 38-year-old male (an intravenous drug abuser) diagnosed with tricuspid valve IE who underwent tricuspid valve replacement. The case was complicated by multiple lung abscesses and thoracic empyema. The pathogens causing the lung abscesses and empyema were Acinetobacter baumannii complex and Candida albicans, which were different from those causing the endocarditis. After 4 weeks of antibiotic treatment, chest X-ray revealed bilateral clear lung markings with only mild blunting of the right costophrenic angle.
CONCLUSION
The pathogen causing the lung abscess is not always compatible with that causing the endocarditis. Thoracoscopic incision of the abscess with 4 to 6 weeks of broad-spectrum antibiotic treatment is effective and safe.
背景
仅4.1%的三尖瓣感染性心内膜炎（IE）病例需要手术干预。三尖瓣IE合并肺脓肿和脓胸的并发症较为罕见。
病例介绍
我们报告一例38岁男性（静脉吸毒者），被诊断为三尖瓣IE并接受了三尖瓣置换术。该病例并发多处肺脓肿和胸腔脓胸。导致肺脓肿和脓胸的病原体为鲍曼不动杆菌复合体和白色念珠菌，与引起心内膜炎的病原体不同。经过4周抗生素治疗后，胸部X线显示双侧肺纹理清晰，仅右肋膈角轻度变钝。
结论
引起肺脓肿的病原体并不总是与引起心内膜炎的病原体一致。胸腔镜下脓肿切开术联合4至6周的广谱抗生素治疗有效且安全。
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