Infective endocarditis due to Staphylococcus aureus involving three cardiac valves. A case study.
A 20-year-old woman, diagnosed with coarctation of the aorta, situs viscerum inversus, and bicuspid aortic valve, underwent corrective surgery for the coarctation. After a postoperative neurological state that suggested a spinal lesion, corticosteroid therapy was initiated and the patient was discharged early from the unit to begin a motor rehabilitation program. Following the dehiscence of the thoracotomy surgical wound, a severe infective clinical picture, sustained by methicillin-resistant S. Aureus (MRSA), became evident with a diagnosis of bacterial endocarditis involving the aortic, mitral and tricuspid valves and caused the patient's death due to septic shock complicated by ARDS. According to the authors, the early discharge of the patients after such a complex operation, the eccessive lengthening of the steroid therapy that would have contribuited to delay the diagnosis, causing the lack of preventing identification of the first signs of infection and the impossibility for the patient to have another operation (involving 3 valves) are conclusive elements that led to the above mentioned complications.
Maglioni
E
E
Division of Post-Cardiosurgical Intensive Care, Le Scotte Hospital, Siena, Italy. magliobuc@libero.it
Garosi
M
M
Marchetti
L
L
Galluzzi
P
P
Marri
D
D
Biagioli
B
B
D000015:Abnormalities, Multiple; D000328:Adult; D001017:Aortic Coarctation / Q000601:surgery*; D004697:Endocarditis, Bacterial / Q000175:diagnosis / Q000209:etiology / Q000382:microbiology*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007511:Ischemia / Q000188:drug therapy / Q000209:etiology; D016106:Methicillin Resistance; D008775:Methylprednisolone / Q000009:adverse effects / Q000627:therapeutic use; D011183:Postoperative Complications / Q000188:drug therapy / Q000382:microbiology*; D012772:Shock, Septic / Q000382:microbiology; D012857:Situs Inversus; D013116:Spinal Cord / Q000098:blood supply; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000209:etiology / Q000382:microbiology*; D013211:Staphylococcus aureus / Q000187:drug effects; D013530:Surgical Wound Infection / Q000382:microbiology
D008775:Methylprednisolone