Tvito Ariella, Rokach Ariel, Ben-David Eliel, Simons Moshe, Heyman Samuel Noam
Department of Hematology, Shaare Zedek Medical Center, Jerusalem, Israel.
Pulmonary Institute, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Eur J Case Rep Intern Med. 2023 Sep 5;10(10):004044. doi: 10.12890/2023_004044. eCollection 2023.
Intracranial haemorrhage may complicate infective endocarditis, caused by ruptured mycotic aneurysms or haemorrhagic transformation of brain septic emboli. The risk of intracranial bleeding may increase with the use of non-steroidal anti-inflammatory agent (NSAIDs).
We report on a 53-year-old male patient with a past history of intravenous drug abuse, who was treated with diclofenac (75 mg IM) for a few hours of preceding fever and arthralgia. Seven hours later he was hospitalised with impaired consciousness and hemiparesis. Evaluation revealed multiple intracranial haemorrhages, at least one originating from a mycotic aneurysm. Repeated blood cultures grew methicillin-resistant (MRSA), and echocardiography revealed a vegetation on the mitral valve, establishing the diagnosis of bacterial endocarditis.
The abrupt simultaneous multifocal intracranial bleeds shortly following the administration of NSAIDs for a few hours of febrile disease, one clearly originating from a mycotic aneurism, are exceptional. This raises a possibility of a role for diclofenac the intracranial bleeding diathesis in this unique clinical presentation. Intracranial haemorrhage in the set-up of undiagnosed infective endocarditis (IE) might be added to the long list of potential adverse outcomes of NSAID administration, and the possibility of IE should be considered before their administration for febrile disease of undetermined cause.
Intracranial haemorrhage in the set-up of undiagnosed infective endocarditis might be added to the long list of potential adverse outcomes of NSAID administration.The possibility of infective endocarditis should be considered before the administration of NSAIDs for febrile disease of an undetermined cause.
颅内出血可能是感染性心内膜炎的并发症，由感染性动脉瘤破裂或脑脓毒性栓子的出血性转化引起。使用非甾体抗炎药（NSAIDs）可能会增加颅内出血的风险。
我们报告一名53岁有静脉药物滥用史的男性患者，因之前数小时的发热和关节痛接受双氯芬酸（75mg肌肉注射）治疗。7小时后，他因意识障碍和偏瘫入院。评估发现多处颅内出血，至少一处源自感染性动脉瘤。多次血培养培养出耐甲氧西林金黄色葡萄球菌（MRSA），超声心动图显示二尖瓣有赘生物，确诊为细菌性心内膜炎。
在因发热性疾病使用NSAIDs数小时后突然同时出现多灶性颅内出血，其中一处明显源自感染性动脉瘤，这种情况很罕见。这增加了双氯芬酸在此独特临床表现中导致颅内出血素质的可能性。在未确诊的感染性心内膜炎（IE）情况下发生的颅内出血可能会被添加到NSAIDs使用的众多潜在不良后果中，并且在因不明原因的发热性疾病使用NSAIDs之前应考虑感染性心内膜炎的可能性。
在未确诊的感染性心内膜炎情况下发生的颅内出血可能会被添加到NSAIDs使用的众多潜在不良后果中。在因不明原因的发热性疾病使用NSAIDs之前应考虑感染性心内膜炎的可能性。
