Ochi Tatsuya, Kikuta Shota, Nishimura Takeshi, Ishihara Satoshi
Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, JPN.
Cureus. 2024 Mar 22;16(3):e56747. doi: 10.7759/cureus.56747. eCollection 2024 Mar.
A 36-year-old man presented with abdominal pain, vomiting, and diarrhea. On arrival, his vital signs were remarkable for fever (39.3 °C) and tachycardia (127 beats/min, regular). His abdomen was distended, and a blood test showed elevations of inflammatory markers. Contrast-enhanced computed tomography revealed a superior mesenteric artery thrombus, ischemic colitis, ascites, and infarctions in the spleen and right kidney. He was diagnosed with bowel necrosis due to acute mesenteric ischemia (AMI). An emergent laparotomy was performed. The following day, was identified in the blood culture. In addition, transthoracic echocardiography revealed vegetation on the mitral valve leaflet. These findings were suggestive of infective endocarditis (IE) caused by ( endocarditis); thus, the patient underwent surgical mitral valve replacement with the administration of antifungal therapy. Following postoperative intensive care and a prolonged course of antifungal treatment, he achieved a full recovery. AMI is only rarely caused by IE, and this case is the first reported instance of AMI secondary to endocarditis. When encountering patients with AMI without any risk factors for thromboembolism, clinicians should be aware that IE may cause AMI.
一名36岁男性出现腹痛、呕吐和腹泻症状。入院时,其生命体征表现为发热(39.3℃)和心动过速(127次/分钟,规律)。他的腹部膨隆,血液检查显示炎症标志物升高。增强计算机断层扫描显示肠系膜上动脉血栓形成、缺血性结肠炎、腹水以及脾脏和右肾梗死。他被诊断为急性肠系膜缺血(AMI)导致的肠坏死。遂进行了急诊剖腹手术。第二天,血培养中发现了[具体病菌]。此外,经胸超声心动图显示二尖瓣叶上有赘生物。这些发现提示由[具体病菌]([病菌名称]性心内膜炎)引起的感染性心内膜炎(IE);因此,患者在接受抗真菌治疗的同时接受了二尖瓣置换手术。经过术后重症监护和长时间的抗真菌治疗,他完全康复。AMI很少由IE引起,该病例是首例报告的继发于[病菌名称]性心内膜炎的AMI。当遇到没有任何血栓栓塞危险因素的AMI患者时,临床医生应意识到IE可能导致AMI。