Cardiobacterium hominis endocarditis associated with very severe thrombocytopenia and platelet autoantibodies.
Severe thrombocytopenia is a life-threatening condition. It is often associated with immune-mediated platelet destruction or myeloablative chemotherapy. Infective endocarditis has been associated with thrombocytopenia, which, as in sepsis, tends to be mild and is often the result of several pathological mechanisms. We report a case of Cardiobacterium hominis endocarditis associated with very severe thrombocytopenia and bleeding in a patient who refused platelet transfusion. Platelet autoantibodies directed against glycoprotein (Gp) IIb/IIIa and Gp Ib/IX were detected during active infection using a glycoprotein-specific assay. Successful treatment of C. hominis endocarditis was associated with loss of platelet autoantibodies and recovery of the platelet count. This report illustrates that the development of platelet autoantibodies can contribute to very severe thrombocytopenia in occasional patients with infective endocarditis.
Department of Hematology, McMaster University, Hamilton, Ontario, Canada.
Donald M
DM
Arnold
Fiona
F
Smaill
Theodore E
TE
Warkentin
Lisa
L
Christjanson
Irwin
I
Walker
D000667:Ampicillin / Q000627:therapeutic use; D016824:Antigens, Human Platelet / Q000276:immunology*; D001024:Aortic Valve Stenosis / Q000601:surgery; D001323:Autoantibodies / Q000097:blood*; D001327:Autoimmune Diseases / Q000209:etiology* / Q000276:immunology; D016470:Bacteremia / Q000150:complications / Q000382:microbiology; D001853:Bone Marrow / Q000382:microbiology; D044066:Cardiobacterium / Q000302:isolation & purification*; D002443:Ceftriaxone / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000627:therapeutic use; D003951:Diagnostic Errors; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D004697:Endocarditis, Bacterial / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology* / Q000628:therapy; D005839:Gentamicins / Q000627:therapeutic use; D016905:Gram-Negative Bacterial Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D006350:Heart Valve Prosthesis; D015616:Histiocytosis, Non-Langerhans-Cell / Q000209:etiology; D006801:Humans; D033221:Jehovah's Witnesses; D008297:Male; D008875:Middle Aged; D017713:Platelet Transfusion / Q000523:psychology; D011183:Postoperative Complications / Q000382:microbiology; D011696:Purpura, Thrombocytopenic / Q000175:diagnosis; D013159:Splenic Infarction / Q000209:etiology; D013921:Thrombocytopenia / Q000175:diagnosis / Q000209:etiology* / Q000276:immunology; D016312:Treatment Refusal
D016824:Antigens, Human Platelet; D001323:Autoantibodies; D005839:Gentamicins; D002939:Ciprofloxacin; D002443:Ceftriaxone; D000667:Ampicillin