title: [Infective endocarditis caused by Chlamydia pneumoniae after liver transplantation. Case report].
abstract: The incidence of infective endocarditis is underestimated in solid organ transplant recipients. The spectrum of pathogens is different from the general population. The authors report the successful treatment of a 58-year-old woman with infective endocarditis caused by atypical microorganism and presented with atypical manifestations. Past history of the patient included alcoholic liver cirrhosis and cadaver liver transplantation in February 2000. One year after liver transplantation hepatitis B virus infection was diagnosed and treated with antiviral agents. In July 2007 hemodialysis was started due to progressive chronic kidney disease caused by calcineurin toxicity. In November 2013 the patient presented with transient aphasia. Transesophageal echocardiography revealed vegetation in the aortic valve and brain embolization was identified on magnetic resonance images. Initial treatment consisted of a 4-week regimen with ceftriaxone (2 g daily) and gentamycin (60 mg after hemodialysis). Blood cultures were all negative while serology revealed high titre of antibodies against Chlamydia pneumoniae. Moxifloxacin was added as an anti-chlamydial agent, but neurologic symptoms returned. After coronarography, valvular surgery and coronary artery bypass surgery were performed which resulted in full clinical recovery of the patient.
authors.affiliation: Belgyógyászati Intézet, Nephrológiai Tanszék, Debreceni Egyetem, Általános Orvostudományi Kar, Klinikai Központ FMC-Debrecen, Nagyerdei krt. 98., 4012.
authors.forename: Réka
authors.initials: R
authors.lastname: P Szabó
authors.forename: Attila
authors.initials: A
authors.lastname: Kertész
authors.forename: Tamás
authors.initials: T
authors.lastname: Szerafin
authors.forename: Imre
authors.initials: I
authors.lastname: Fehérvári
authors.forename: Lajos
authors.initials: L
authors.lastname: Zsom
authors.forename: József
authors.initials: J
authors.lastname: Balla
authors.forename: Balázs
authors.initials: B
authors.lastname: Nemes
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000907:Antibodies, Bacterial / Q000097:blood; D001021:Aortic Valve / Q000382:microbiology* / Q000601:surgery; D001037:Aphasia / Q000209:etiology; D001921:Brain / Q000382:microbiology / Q000473:pathology; D019703:Calcineurin / Q000633:toxicity; D002443:Ceftriaxone / Q000008:administration & dosage; D002689:Chlamydia / Q000276:immunology / Q000302:isolation & purification*; D001026:Coronary Artery Bypass; D004334:Drug Administration Schedule; D017548:Echocardiography, Transesophageal; D004697:Endocarditis, Bacterial / Q000000981:diagnostic imaging / Q000209:etiology* / Q000382:microbiology; D005260:Female; D024841:Fluoroquinolones / Q000008:administration & dosage; D005839:Gentamicins / Q000008:administration & dosage; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D020766:Intracranial Embolism / Q000150:complications / Q000175:diagnosis / Q000382:microbiology*; D016031:Liver Transplantation / Q000009:adverse effects; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D000077266:Moxifloxacin; D006435:Renal Dialysis / Q000009:adverse effects; D051436:Renal Insufficiency, Chronic / Q000209:etiology / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000907:Antibodies, Bacterial; D024841:Fluoroquinolones; D005839:Gentamicins; D002443:Ceftriaxone; D019703:Calcineurin; D000077266:Moxifloxacin
keywords: Chlamydia pneumoniae; infective endocarditis; infektív endocarditis; liver transplantation; májtranszplantáció