Diallo Kévin, Jacquet Caroline, Alauzet Corentine, Beguinot Isabelle, May Thierry, Selton-Suty Christine, Hoen Bruno, Goehringer Francois
Service de Maladies Infectieuses et Tropicales.
Laboratoire de Bactériologie, CHU de Nancy Hôpitaux de Brabois, Vandœuvre-lès-Nancy.
Medicine (Baltimore). 2019 Apr;98(15):e15014. doi: 10.1097/MD.0000000000015014.
Guillain-Barré syndrome (GBS) is an acute inflammatory polyradiculoneuropathy presumed to result from an infection-triggered autoimmune reaction.
This paper describes a 53-year-old man admitted to hospital for deterioration of his general condition.
He developed GBS, confirmed by lumbar puncture and electromyogram, which recovered after intravenous immunoglobulins. A grade 2 aortic regurgitation was detected by transthoracic echocardiography upon diagnosis of GBS, but in the absence of fever, no further investigations were conducted. A few weeks later, the patient presented with fever and infective endocarditis (IE) was diagnosed after the identification of vegetation on the aortic valve with transesophageal echocardiography. The etiologic agent was identified as Cardiobacterium hominis based on 3 positive blood cultures and DNA detection in valvular material.
IE was cured with a 6-week course of antibiotics and aortic valve replacement.
The patient completely recovered from Guillain-Baré syndrome and IE.
This case of GBS associated with C hominis endocarditis, emphasizes the importance of blood cultures and transesophageal echocardiography for the detection of IE and highlights the insidious nature of C hominis endocarditis which is often diagnosed late.
吉兰 - 巴雷综合征（GBS）是一种急性炎症性多发性神经根神经病，推测由感染引发的自身免疫反应所致。
本文描述了一名53岁男性因全身状况恶化入院。
他患上了GBS，经腰椎穿刺和肌电图检查确诊，静脉注射免疫球蛋白后康复。GBS诊断时经胸超声心动图检测发现2级主动脉瓣反流，但因无发热未作进一步检查。几周后，患者出现发热，经食管超声心动图在主动脉瓣发现赘生物后诊断为感染性心内膜炎（IE）。基于3次血培养阳性及瓣膜组织中的DNA检测，病原体被鉴定为人心杆菌。
IE通过6周的抗生素疗程及主动脉瓣置换得以治愈。
患者从吉兰 - 巴雷综合征和IE中完全康复。
该例GBS合并人心杆菌性心内膜炎病例强调了血培养和经食管超声心动图对检测IE的重要性，并突出了人心杆菌性心内膜炎的隐匿性，其往往诊断较晚。
