Nichols Larry, Hernandez Michel, Henderson Iv John H
Pathology, Mercer University School of Medicine, Macon, USA.
Biology, Mercer University School of Medicine, Macon, USA.
Cureus. 2019 Sep 13;11(9):e5645. doi: 10.7759/cureus.5645.
It is important not to miss a diagnosis of infective endocarditis. It is fatal if untreated and most often successfully treatable if recognized. We report a classic case of subacute bacterial endocarditis with Osler nodes and Janeway lesions due to viridans streptococci from an oral source of poor dentition, infecting a presumably abnormal mitral valve. The diagnosis was missed repeatedly by multiple different clinicians over the course of seven months. Detailed analysis of this case suggests some of the pitfalls that led to the delay in diagnosis. The infective endocarditis was masked by analgesic medication, inadequate physical examination, and narrow focus thinking. The images of this case can serve as a reminder of the features of infective endocarditis. The detailed history and discussion can provide potential lessons in how to not miss the diagnosis of infective endocarditis.
不要漏诊感染性心内膜炎，这一点很重要。若不治疗，该病会致命；若能确诊，多数情况下可成功治愈。我们报告一例典型的亚急性细菌性心内膜炎病例，患者因牙列不佳导致口腔来源的草绿色链球菌感染，出现奥斯勒结节和詹韦损害，感染的可能是异常的二尖瓣。在七个月的时间里，多位不同的临床医生多次漏诊。对该病例的详细分析揭示了一些导致诊断延误的陷阱。感染性心内膜炎被止痛药物、体格检查不充分以及思维局限所掩盖。该病例的影像可作为感染性心内膜炎特征的提示。详细的病史及讨论可为如何避免漏诊感染性心内膜炎提供潜在的经验教训。
