Seydou Harouna Idrissa, Fatiha Karim, Yousra Hamine, Adam Fadoul Taher Fadoul, Siyam Hammady, Arous Salim, Abdessamad Drighil
Cardiology department, CHU Ibn Rochd, Casablanca, Morocco.
Ann Cardiol Angeiol (Paris). 2023 Apr;72(2):101578. doi: 10.1016/j.ancard.2022.11.013. Epub 2023 Feb 8.
Infective endocarditis is an uncommon, yet serious disease responsible for high morbidity and mortality, its incidence is estimated at 3-10 cases per 100,000 person-years. Most infective endocarditis cases emanate from streptococcus and staphylococcus. The incrimination of Aeroccocus viridans is rarely described in the literature and it has a high rate of embolic complication. We report the case of a 31-year-old male patient, with no prior medical history, who was admitted to the cardiology department of Ibn Rochd university center due to a prolonged fever for over 6 months. At admission, his general condition was preserved, he was febrile at 38.7 °C, claudication in the right lower limb with a decrease in the peroneal artery pulse, a graded 4/6 diastolic aortic murmur on auscultation, and no signs of heart failure. The transthoracic echocardiography revealed a type I bicuspid aortic valve disease, severe aortic regurgitation, moderate aortic stenosis, and vegetation implanted on the ventricular side of the right coronary cusp. CT angiography of the lower limbs revealed a bilateral total occlusion of the tibioperoneal trunks extended to the proximal portions of the posterior tibial arteries and peroneal arteries with collateral circulation, endovascular collection, and occlusive calcified plaque of the proximal part of the right anterior tibial artery and the collateral circle. Blood tests showed an inflammatory syndrome. Blood cultures detected Aerococcus viridans. The patient was first put on ceftriaxone, gentamycin, unfractionated heparin, and analgesic-antipyretic when necessary, he was then transferred to the cardiovascular surgery department for replacement of the aortic valve and permeabilization of the lower limbs by the FOGARTY technique. Post-surgical results were satisfying. In conclusion, infective endocarditis secondary to Aerococcus viridans is rare but appears to be virulent because most often discovered at the stage of complications. Therefore, good antibiotic therapy adapted to the antibiogram results in a good prognosis.
感染性心内膜炎是一种罕见但严重的疾病，可导致高发病率和死亡率，其发病率估计为每10万人年3 - 10例。大多数感染性心内膜炎病例由链球菌和葡萄球菌引起。文献中很少描述绿色气球菌致病情况，且其栓塞并发症发生率很高。我们报告一例31岁男性患者，既往无病史，因持续发热6个月以上入住伊本·罗奇德大学中心心脏病科。入院时，他的一般状况尚可，体温38.7℃，右下肢间歇性跛行，腓动脉搏动减弱，听诊有4/6级舒张期主动脉杂音，无心力衰竭体征。经胸超声心动图显示I型二叶式主动脉瓣疾病、严重主动脉反流、中度主动脉狭窄，以及右冠状动脉瓣心室侧有赘生物。下肢CT血管造影显示双侧胫腓干完全闭塞，延伸至胫后动脉和腓动脉近端，有侧支循环、血管内积液，右胫前动脉近端及侧支循环有闭塞性钙化斑块。血液检查显示有炎症综合征。血培养检测到绿色气球菌。患者最初接受头孢曲松、庆大霉素、普通肝素治疗，必要时给予止痛退热药物，随后转至心血管外科，通过Fogarty技术置换主动脉瓣并使下肢血管再通。手术结果令人满意。总之，由绿色气球菌引起的感染性心内膜炎很少见，但似乎毒性很强，因为大多数情况下在并发症阶段才被发现。因此，根据药敏试验结果进行良好的抗生素治疗可带来良好预后。
