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诊断难题:感染性心内膜炎的非典型表现。

Diagnostic challenge: an atypical presentation of infective endocarditis.

机构信息

Cardiology, United Lincolnshire Hospitals NHS Trust, Lincoln, Lincolnshire, UK

Cardiology, United Lincolnshire Hospitals NHS Trust, Lincoln, Lincolnshire, UK.

出版信息

BMJ Case Rep. 2021 Jan 25;14(1):e239994. doi: 10.1136/bcr-2020-239994.

Abstract

It is recognised that infective endocarditis is frequently a challenging diagnosis to make, as it may present with a range of non-specific symptoms. A middle-aged man was admitted with an 8-day history of profuse non-bloody diarrhoea and vomiting. He had no medical history and no identifiable risk factors for infective endocarditis, and so this in combination with the patient's atypical symptoms presented a diagnostic challenge. The patient was eventually diagnosed with a right-sided infective endocarditis. This case report explores the events which led to this diagnosis and demonstrates a number of unique learning points. It also highlights the importance of maintaining an open mind and being prepared to revise an initial diagnosis in the face of medical uncertainty.

摘要

人们认识到,感染性心内膜炎的诊断常常具有挑战性,因为它可能表现出一系列非特异性症状。一名中年男子因 8 天来大量非血性腹泻和呕吐而入院。他没有既往病史,也没有可识别的感染性心内膜炎危险因素,因此,结合患者的非典型症状,这对诊断提出了挑战。该患者最终被诊断为右侧感染性心内膜炎。本病例报告探讨了导致该诊断的事件,并展示了一些独特的学习要点。它还强调了在面对医学不确定性时保持开放思维并准备修改初始诊断的重要性。

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本文引用的文献

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Infective Endocarditis: A Contemporary Review.感染性心内膜炎:当代综述。
Mayo Clin Proc. 2020 May;95(5):982-997. doi: 10.1016/j.mayocp.2019.12.008. Epub 2020 Apr 13.
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Pediatr Nephrol. 2017 Apr;32(4):577-587. doi: 10.1007/s00467-016-3394-5. Epub 2016 May 7.
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Infective endocarditis.感染性心内膜炎。
BMJ. 2006 Aug 12;333(7563):334-9. doi: 10.1136/bmj.333.7563.334.

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