Woodun Heerani, Bouayyad Sarah, Sahib Sura, Elamin Nadir, Hunter Steven, Al-Mohammad Abdallah
Cardiology Department, Sheffield Teaching Hospitals, Sheffield S5 7AU, UK.
ENT Department, Tameside General Hospital, Ashton-Under-Lyne OL6 9RW, UK.
Oxf Med Case Reports. 2020 Jul 24;2020(7):omaa045. doi: 10.1093/omcr/omaa045. eCollection 2020 Jul.
A 29-year-old male, with chronic atopic dermatitis (AD), presented with a 2-week history of fatigue, pyrexia and weight loss. Examination showed eczematous patches with lichenified papules, erosions on the right shin and a new murmur. Blood cultures isolated methicillin-sensitive . Transthoracic echocardiography showed vegetation on the tricuspid valve (TV) that was adherent to the septal leaflet. He was treated for infective endocarditis, attributed to poorly controlled AD, with intravenous Flucloxacillin. Due to ongoing sepsis and pulmonary septic emboli, Clindamycin was added. He underwent TV repair; the septal leaflet was excised, and the remnant two leaflets were brought together with a ring. His patent foramen ovale was closed. His skin was treated with topical steroids and emollients. Right-sided endocarditis of an intact TV is uncommon in a non-intravenous drug user. Therefore, this novel case portrays the importance of aggressively managing AD as it is a risk factor for significant systemic infections.
一名29岁患有慢性特应性皮炎（AD）的男性，出现了为期2周的疲劳、发热和体重减轻症状。检查发现有湿疹样斑块伴苔藓化丘疹，右小腿有糜烂，且有新出现的杂音。血培养分离出对甲氧西林敏感的……经胸超声心动图显示三尖瓣（TV）上有赘生物，附着于隔叶。他因AD控制不佳导致感染性心内膜炎而接受静脉注射氟氯西林治疗。由于持续存在败血症和肺脓毒性栓子，加用了克林霉素。他接受了三尖瓣修复；切除了隔叶，将剩余的两个瓣叶用一个环并拢。他的卵圆孔未闭得到了闭合。他的皮肤用外用类固醇和润肤剂进行治疗。在非静脉吸毒者中，完整三尖瓣的右侧心内膜炎并不常见。因此，这个新病例表明积极治疗AD非常重要，因为它是严重全身感染的一个危险因素。
