Ito Arisa, Miyagami Taiju, Suzuki Mayu, Nishina Tsubasa, Naito Toshio
Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, JPN.
General Medicine, Jyuntendo University Hospital, Tokyo, JPN.
Cureus. 2023 Dec 6;15(12):e50081. doi: 10.7759/cureus.50081. eCollection 2023 Dec.
(GAS) is a common organism that can cause upper respiratory infections. We encountered a case where GAS caused infective endocarditis (IE) due to an entry from the vagina. In this case, although echocardiography was negative, we were able to make a diagnosis of IE based on the 2023 Duke International Society for Cardiovascular Infectious Diseases Criteria, and we started antimicrobial therapy for IE. However, the patient subsequently developed persistent abdominal pain, which was atypical; hence, we reviewed the differential diagnosis. It is difficult to locate the primary site of infection because GAS rarely causes vaginal infections, and vaginal infections rarely cause IE. This case highlights the significance of revisiting medical history and the value of using a system 3 approach to refine diagnostic directions.
A群链球菌（GAS）是一种可引起上呼吸道感染的常见病原体。我们遇到了一例因经阴道途径感染而导致感染性心内膜炎（IE）的A群链球菌病例。在该病例中，尽管超声心动图检查结果为阴性，但我们依据2023年心血管感染性疾病国际学会杜克标准确诊为IE，并开始了针对IE的抗菌治疗。然而，患者随后出现了持续的腹痛，这一症状并不典型；因此，我们重新审视了鉴别诊断。由于A群链球菌很少引起阴道感染，而阴道感染也很少导致IE，所以很难确定感染的原发部位。该病例凸显了回顾病史的重要性以及采用系统3方法来完善诊断方向的价值。
