Aortic and tricuspid endocarditis in hemodialysis patient with systemic and pulmonary embolism.
This is a case report of a 43-year-old Caucasian male with end-stage renal disease being treated with hemodialysis and infective endocarditis in the aortic and tricuspid valves. The clinical presentation was dominated by neurologic impairment with cerebral embolism and hemorrhagic components. A thoracoabdominal computerized tomography scan revealed septic pulmonary embolus. The patient underwent empirical antibiotherapy with ceftriaxone, gentamicin and vancomycin, and the therapy was changed to flucloxacilin and gentamicin after the isolation of S. aureus in blood cultures. The multidisciplinary team determined that the patient should undergo valve replacement after the stabilization of the intracranial hemorrhage; however, on the 8th day of hospitalization, the patient entered cardiac arrest due to a massive septic pulmonary embolism and died. Despite the risk of aggravation of the hemorrhagic cerebral lesion, early surgical intervention should be considered in high-risk patients.
Departamento de Cardiologia, Hospitalar de Lisboa Central, Lisboa, Portugal.
Silvia Aguiar
SA
Rosa
Unidade de Urgência Médica, Centro Hospitalar de Lisboa Central, Lisboa, Portugal.
Nuno
N
Germano
Unidade de Urgência Médica, Centro Hospitalar de Lisboa Central, Lisboa, Portugal.
Ana
A
Santos
Unidade de Urgência Médica, Centro Hospitalar de Lisboa Central, Lisboa, Portugal.
Luis
L
Bento
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001021:Aortic Valve / Q000382:microbiology / Q000473:pathology; D004697:Endocarditis, Bacterial / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology*; D017809:Fatal Outcome; D006323:Heart Arrest / Q000209:etiology; D006349:Heart Valve Diseases / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D011655:Pulmonary Embolism / Q000150:complications / Q000382:microbiology / Q000473:pathology*; D006435:Renal Dialysis / Q000379:methods*; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology; D013211:Staphylococcus aureus / Q000302:isolation & purification; D014261:Tricuspid Valve / Q000382:microbiology / Q000473:pathology
D000900:Anti-Bacterial Agents