Lacalzada-Almeida Juan, Izquierdo-Gomez Maria Manuela, Duque-Gonzalez Amelia, Alonso-Socas Maria Del Mar, Munoz-Rodriguez Rebeca
Department of Cardiology, Hospital Universitario de Canarias, Tenerife, Spain.
Department of Infectious Diseases, Hospital Universitario de Canarias, Tenerife, Spain.
J Med Cases. 2022 Jun;13(6):297-301. doi: 10.14740/jmc3943. Epub 2022 Jun 11.
We report the case of a 53-year-old man with psoriatic arthritis, suffering from a malignant and recidivant myoepithelioma in his right axilla and arm, and undergoing two surgeries, with the last one being performed a month prior to actual admission. After the last surgery, he was admitted to hospital with fever without a source. After physical examination, laboratory tests, blood cultures and transthoracic and transesophageal echocardiography, he was diagnosed with infectious endocarditis (IE) on a bicuspid aortic valve (BAV) caused by (PA). Antibiogram-guided antibiotic therapy with meropenem and tobramicin was initiated. However, in the presence of repetitive spleen infarctions and a large vegetation, 12 days after admission, a bioprosthesis aortic valve implantation was performed. The postsurgical evolution was favorable and prolonged antibiotic course with meropenem and tobramicin was completed. The pathological anatomy and the native valve cultured confirmed an IE caused by PA. Gram-negative non-HACEK IE cases are infrequent, accounting for 1.8% of the total IE cases. PA is the second most frequent bacillus in this group, causing endocarditis more prevalently when associated with healthcare procedures rather than injectable drug use. No prior case study has identified IE caused by PA related to a BAV in the last years.
我们报告了一例53岁患有银屑病关节炎的男性病例，其右腋窝和手臂患有恶性复发性肌上皮瘤，并接受了两次手术，最后一次手术在实际入院前一个月进行。最后一次手术后，他因不明原因发热入院。经过体格检查、实验室检查、血培养以及经胸和经食管超声心动图检查，他被诊断为双叶主动脉瓣（BAV）感染性心内膜炎（IE），由洋葱伯克霍尔德菌（PA）引起。开始使用美罗培南和妥布霉素进行抗生素药敏试验指导下的抗生素治疗。然而，由于存在反复的脾梗死和巨大赘生物，入院12天后进行了生物假体主动脉瓣植入术。术后病情进展良好，完成了美罗培南和妥布霉素的延长抗生素疗程。病理解剖和天然瓣膜培养证实为PA引起的IE。革兰阴性非HACEK IE病例并不常见，占IE总病例的1.8%。PA是该组中第二常见的杆菌，与医疗保健程序相关时比注射吸毒更易引起心内膜炎。近年来没有先前的病例研究发现PA引起的IE与BAV相关。
