School of Medicine, Creighton University Phoenix Regional Campus, Phoenix, Arizona, USA
Barrow Neurological Institute, Phoenix, Arizona, USA.
BMJ Case Rep. 2024 Oct 30;17(10):e263020. doi: 10.1136/bcr-2024-263020.
Our case highlights an atypical presentation of endocarditis with acute ischaemic stroke in a male patient in his 60s. The patient had undergone a congenital bicuspid aortic valve replacement with a bioprosthetic valve and an ascending aortic root graft with a pacemaker. He experienced intermittent fevers, chills and malaise over 15 months leading up to his presentation. During our diagnostic process, we used the newly developed Karius test, which detects microbial cell-free DNA in the patient's serum. The patient was treated with doxycycline and hydroxychloroquine for 24 months along with surgical removal and replacement of his aortic valve and graft. Our case underscores the utility of the Karius test and the essential role of neurology in the multidisciplinary team.
我们的病例突出了一位 60 多岁男性患者的感染性心内膜炎伴急性缺血性脑卒中的非典型表现。该患者曾因先天性二叶主动脉瓣置换术接受生物瓣置换和升主动脉根部移植及起搏器治疗。在出现症状前的 15 个月中，他间歇性出现发热、寒战和不适。在诊断过程中，我们使用了新开发的 Karius 检测，该检测可检测患者血清中的微生物无细胞 DNA。该患者接受了 24 个月的多西环素和羟氯喹治疗，并进行了主动脉瓣和移植物的外科切除和置换。我们的病例强调了 Karius 检测的实用性和神经科在多学科团队中的重要作用。
