title: Successful treatment, despite a non-surgical approach, of severe infective endocarditis.
abstract: A 60-year-old man with a history of Child-Pugh class B cirrhosis was admitted to the hospital with 4-5 days of nausea, vomiting and altered mental status. Following the development of fever in the intensive care unit and methicillin-sensitive Staphylococcus aureus bacteraemia, a large (15 mm) vegetation was discovered on the anterolateral papillary muscle of the mitral valve. Following a thorough multidisciplinary evaluation, the patient was considered to be a poor surgical candidate due to the significant perioperative complications associated with Child-Pugh class B cirrhosis. The patient was treated with 6 weeks intravenous nafcillin as an outpatient. Echocardiography following the treatment course revealed that the vegetation had completely resolved without any valvular dysfunction. This case report emphasises that medical management remains an effective alternative to surgery in complicated cases of infective endocarditis.
authors.affiliation: University of Colorado School of Medicine, Aurora, Colorado, USA.
authors.forename: Peter K
authors.initials: PK
authors.lastname: Boulos
authors.forename: Mark Y
authors.initials: MY
authors.lastname: Jeong
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003937:Diagnosis, Differential; D004452:Echocardiography; D004697:Endocarditis, Bacterial / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000382:microbiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009254:Nafcillin / Q000627:therapeutic use*; D013203:Staphylococcal Infections / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents; D009254:Nafcillin