Watkins Rhys, Marincowitz Carl, Locke Thomas, Hunter Steven
Northern General Hospital Emergency Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
Centre for Urgent and Emergency Care Research (CURE), School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK.
BMJ Case Rep. 2022 Dec 21;15(12):e249214. doi: 10.1136/bcr-2022-249214.
A man in his 20s attended the emergency department with three days of fever, headache, reduced appetite and a sore throat. COVID-19 point-of-care test was negative. Blood cultures grew a gram-negative coccobacillus, Following an episode of confusion, MRI head revealed septic emboli. Prolapse of the mitral valve with regurgitation was noted on echocardiography. Infection was found to have originated from multiple dental caries and treatment required a combination of dental extraction, prolonged antibiotic therapy and surgery for mitral valve repair. is part of the normal oropharyngeal flora but is also a rare cause of endocarditis. There are no established treatment guidelines for endocarditis of this aetiology. endocarditis may present atypically, with a murmur only developing several days later. 'Classical' stigmata should not be relied on to make a diagnosis. predominantly affects the left side of the heart and predisposes to embolic events.
一名20多岁的男子因发热、头痛、食欲减退和喉咙痛三天前往急诊科就诊。新冠病毒即时检测呈阴性。血培养培养出一种革兰氏阴性球杆菌，在一次意识模糊发作后，头部磁共振成像显示有脓毒性栓子。超声心动图显示二尖瓣脱垂伴反流。发现感染源于多个龋齿，治疗需要拔牙、长期抗生素治疗和二尖瓣修复手术相结合。（该菌）是正常口咽菌群的一部分，但也是心内膜炎的罕见病因。对于这种病因的心内膜炎，目前尚无既定的治疗指南。心内膜炎可能表现不典型，杂音可能在数天后才出现。不应依赖“典型”体征来做出诊断。（该菌）主要影响心脏左侧，易引发栓塞事件。
