Nakajima Tomohiro, Iba Yutaka, Shibata Tsuyoshi, Iwashiro Yu, Kawaharada Nobuyoshi
Cardiovascular Surgery, Sapporo Medical University, Sapporo, JPN.
Cureus. 2024 Nov 12;16(11):e73564. doi: 10.7759/cureus.73564. eCollection 2024 Nov.
A 63-year-old man was diagnosed with myelodysplastic syndrome (MDS) at the age of 62 by the hematology department. The patient underwent four cycles of azacitidine (AZA) therapy, followed by successful bone marrow transplantation (BMT). Subsequently, he was hospitalized twice for graft-versus-host disease (GVHD). Prednisolone was initially administered at 60 mg and was gradually tapered to 10 mg/day. Additionally, the patient was prescribed 10 mg/day of a Janus kinase inhibitor. At age 63, approximately one month prior to admission, he began experiencing recurrent upper respiratory symptoms with fevers of around 37°C. He developed a persistent fever of 38°C, accompanied by dyspnea on exertion, and visited the hematology outpatient clinic. Chest radiography revealed prominent pulmonary congestion, leading to the decision to perform echocardiography, which revealed severe aortic valve regurgitation with vegetation attached to the valve. Laboratory findings included a white blood cell count of 13,200/μL and a C-reactive protein (CRP) level of 13.7 mg/dL. Blood cultures revealed the presence of gram-positive cocci. As the patient's respiratory condition progressively worsened, emergency aortic valve replacement was planned. Additionally, because of a history of percutaneous coronary intervention (PCI) at another institution, he was referred for a coronary artery bypass graft (CABG) on the right coronary artery to be performed concurrently. Surgery was performed via median sternotomy under cardioplegic arrest. The aortic valve was perforated at the right coronary cusp and was covered with vegetation. The patient underwent aortic valve replacement with a biological valve, and a saphenous vein graft was used for bypass grafting to the posterior descending branch of the right coronary artery. Postoperatively, antibiotic therapy was administered without infection recurrence. The patient was discharged 47 days postoperatively. This case demonstrated the rapid progression of infective endocarditis following BMT, highlighting the need for prompt recognition and management.
一名63岁男性在62岁时被血液科诊断为骨髓增生异常综合征（MDS）。该患者接受了四个周期的阿扎胞苷（AZA）治疗，随后成功进行了骨髓移植（BMT）。随后，他因移植物抗宿主病（GVHD）住院两次。最初给予泼尼松龙60mg，逐渐减量至10mg/天。此外，患者还被处方了10mg/天的Janus激酶抑制剂。63岁时，入院前约一个月，他开始出现反复的上呼吸道症状，体温约37°C。他出现了持续38°C的发热，伴有活动时呼吸困难，并前往血液科门诊就诊。胸部X线检查显示肺部明显充血，因此决定进行超声心动图检查，结果显示严重的主动脉瓣反流，瓣膜上附着有赘生物。实验室检查结果包括白细胞计数为13200/μL，C反应蛋白（CRP）水平为13.7mg/dL。血培养显示存在革兰氏阳性球菌。随着患者呼吸状况逐渐恶化，计划进行紧急主动脉瓣置换术。此外，由于他在另一家机构有经皮冠状动脉介入治疗（PCI）的病史，他被转诊同时进行右冠状动脉冠状动脉旁路移植术（CABG）。手术通过正中胸骨切开术在心脏停搏下进行。主动脉瓣在右冠状动脉瓣叶处穿孔，表面覆盖有赘生物。患者接受了生物瓣膜主动脉瓣置换术，并使用大隐静脉移植至右冠状动脉后降支进行旁路移植。术后给予抗生素治疗，未出现感染复发。患者术后47天出院。该病例显示了骨髓移植后感染性心内膜炎的快速进展，强调了及时识别和处理的必要性。
