Jayasinghe Gayashani K, Dinusha Logeswaran, Perera Udara S, Jegarajah Indrakumar
Colombo South Teaching Hospital, Colombo, Sri Lanka.
Faculty of Medical Sciences, University of Sri Jayewardenepura, Colombo, Sri Lanka.
J Int Med Res. 2025 Jan;53(1):3000605241311778. doi: 10.1177/03000605241311778.
A 70-year-old man developed intermittent fever with chills, severe anorexia, generalized weakness, and mild exertional difficulty in breathing following posterior chamber intraocular lens replacement surgery for a mature white cataract in the left eye. Laboratory tests revealed persistent negative blood cultures, normocytic and normochromic anemia, neutrophilia, and elevated inflammatory markers despite multiple courses of antibiotics. All other investigations conducted to identify the cause of prolonged fever, including transthoracic echocardiography, were negative. However, transesophageal echocardiography detected an aortic valve vegetation. The patient had no history of valvular disease or any predisposing condition for infective endocarditis. The bacteremia was strongly suspected to have resulted from cataract surgery, although no obvious signs of eye infection were observed during the postoperative period. The patient was treated with empirical antibiotics, including vancomycin and ceftriaxone, which led to significant improvement. Because infective endocarditis remains a significant public health concern with increasing incidence rates, we present this unusual case of culture-negative infective endocarditis following cataract surgery, highlighting the diagnostic and therapeutic challenges encountered.
一名70岁男性在左眼成熟白色白内障后房型人工晶状体置换手术后出现间歇性发热伴寒战、严重厌食、全身乏力以及轻度劳力性呼吸困难。实验室检查显示，尽管接受了多疗程抗生素治疗，血培养持续阴性，正细胞正色素性贫血，中性粒细胞增多，炎症标志物升高。为确定长期发热原因所进行的所有其他检查，包括经胸超声心动图，均为阴性。然而，经食管超声心动图检测到主动脉瓣赘生物。该患者无瓣膜病病史或任何感染性心内膜炎的易感因素。尽管术后未观察到明显的眼部感染迹象，但强烈怀疑菌血症是由白内障手术引起的。患者接受了经验性抗生素治疗，包括万古霉素和头孢曲松，病情显著改善。由于感染性心内膜炎的发病率不断上升，仍然是一个重大的公共卫生问题，我们报告了这例白内障手术后罕见的血培养阴性感染性心内膜炎病例，突出了所遇到的诊断和治疗挑战。
