Mittermayer H, Nesser H J, Ohlinger W
Infection. 1983 Nov-Dec;11(6):302-6. doi: 10.1007/BF01641351.
We are presenting a case of endocarditis due to a penicillin-tolerant Streptococcus bovis in a 65-year-old patient. The minimal bactericidal concentration of penicillin (40 mg/l) was more than 100-fold the minimal inhibitory concentration (0.08 mg/l). The MBC of penicillin was 0.31 mg/l in the presence of 1.25 mg/l gentamicin. Cross-sectional echocardiography revealed endocarditis of the anterior leaflet of the tricuspid valve and a vegetation on the aortic valve which appeared to be pedunculated and which prolapsed into the left ventricular outflow tract during diastole. During therapy, the pedunculated part of the vegetation disappeared without signs of embolization. After initial clinical improvement, the patient died of cerebral bleeding caused by a mycotic aneurysm of the left median cerebral artery. The patient's final outcome suggested an asymptomatic embolus. Cross-sectional echocardiography was distinctly superior to M-mode echocardiography in estimating changes in the size and shape of the valve vegetation. The results of the post-mortem examination of the aortic and tricuspid valves corresponded to the echocardiographic findings.
我们报告一例65岁患者因耐青霉素牛链球菌引起的心内膜炎。青霉素的最低杀菌浓度（40mg/L）比最低抑菌浓度（0.08mg/L）高100多倍。在存在1.25mg/L庆大霉素的情况下，青霉素的MBC为0.31mg/L。横断面超声心动图显示三尖瓣前叶心内膜炎以及主动脉瓣上有一个赘生物，该赘生物似乎有蒂，在舒张期脱垂至左心室流出道。在治疗期间，赘生物的蒂状部分消失，无栓塞迹象。在最初的临床症状改善后，患者死于左大脑中动脉霉菌性动脉瘤引起的脑出血。患者的最终结局提示存在无症状栓子。在评估瓣膜赘生物的大小和形状变化方面，横断面超声心动图明显优于M型超声心动图。主动脉瓣和三尖瓣的尸检结果与超声心动图检查结果相符。
