Johnson Bryce V, Kumbhakar Raaka G, Corcorran Maria A, Burke Christopher R, Krieger Eric V
Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA.
Department of Medicine, Division of Allergy and Infectious Disease, University of Washington, Seattle, Washington, USA.
JACC Case Rep. 2024 Sep 4;29(17):102492. doi: 10.1016/j.jaccas.2024.102492.
A 38-year-old patient with a prosthetic aortic valve had weeks of fever and respiratory symptoms. Although endocarditis was suspected early, numerous blood cultures and echocardiograms failed to confirm the diagnosis. Key questions were: What is a broad differential diagnosis for the above symptoms? What is unique about diagnosing prosthetic valve endocarditis compared with native valve endocarditis? What other imaging modalities are useful for diagnosing prosthetic valve endocarditis when initial echocardiographic evaluation is negative? What organisms are classically implicated in "culture negative" infective endocarditis? Serial blood cultures and multimodal imaging, including cardiac positron emission computed tomography with 18F-fluorodeoxyglucose, lead to a diagnosis of prosthetic valve endocarditis with a HACEK () pathogen. Repeat blood cultures and serial multimodal imaging are paramount to diagnosing prosthetic valve endocarditis, particularly when caused by a fastidious organism.
一名患有人工主动脉瓣的38岁患者持续数周发热并伴有呼吸道症状。尽管早期怀疑患有心内膜炎，但多次血培养和超声心动图检查均未能确诊。关键问题是：上述症状的广泛鉴别诊断是什么？与天然瓣膜心内膜炎相比，人工瓣膜心内膜炎的诊断有何独特之处？当初次超声心动图评估为阴性时，还有哪些其他影像学检查方法对诊断人工瓣膜心内膜炎有用？哪些微生物通常与“血培养阴性”感染性心内膜炎有关？连续血培养和多模态成像，包括18F-氟脱氧葡萄糖心肌正电子发射计算机断层扫描，最终诊断为人工瓣膜心内膜炎，病原体为HACEK（）。重复血培养和连续多模态成像对于诊断人工瓣膜心内膜炎至关重要，尤其是由苛养菌引起的感染。
