title: A massive haemothorax as an unusual complication of infective endocarditis caused by Streptococcus sanguinis.
abstract: OBJECTIVE
  Infective endocarditis involving the tricuspid valve is an uncommon condition, and a consequent haemothorax associated with pulmonary embolism is extremely rare. Particularly, there are no guidelines for the management of this complication. We describe a rare case of pulmonary embolism and infarction followed by a haemothorax due to infective endocarditis of the tricuspid valve caused by Streptococcus sanguinis.
  
  
  METHODS
  A 25-year-old man with a ventricular septal defect (VSD) presented with fever. On physical examination, his body temperature was 38.8 °C, and a grade III holosystolic murmur was heard. A chest X-ray did not reveal any specific findings. A transoesophageal echocardiogram showed a perimembranous VSD and echogenic material attached to the tricuspid valve. All blood samples drawn from three different sites yielded growth of pan-susceptible S. sanguinis in culture bottles. On day 12 of hospitalization, the patient complained of pleuritic chest pain without fever. Physical examination revealed reduced breathing sounds and dullness in the lower left thorax. On his chest computed tomography scan, pleural effusion with focal infarction and pulmonary embolism were noted on the left lower lung. Thoracentesis indicated the presence of a haemothorax.
  
  
  METHODS
  Our case was successfully treated using antibiotic therapy alone with adjunctive chest tube insertion, rather than with anticoagulation therapy for pulmonary embolism or cardiac surgery.
  
  
  CONCLUSIONS
  When treating infective endocarditis caused by S. sanguinis, clinicians should include haemothorax in the differential diagnosis of patients complaining of sudden chest pain.
authors.affiliation: a Division of Infectious Diseases, Department of Internal Medicine , Korea University College of Medicine , Seoul , South Korea.
authors.forename: Kyoung Jin
authors.initials: KJ
authors.lastname: Kim
authors.affiliation: a Division of Infectious Diseases, Department of Internal Medicine , Korea University College of Medicine , Seoul , South Korea.
authors.forename: Kang Won
authors.initials: KW
authors.lastname: Lee
authors.affiliation: a Division of Infectious Diseases, Department of Internal Medicine , Korea University College of Medicine , Seoul , South Korea.
authors.forename: Ju Hee
authors.initials: JH
authors.lastname: Choi
authors.affiliation: a Division of Infectious Diseases, Department of Internal Medicine , Korea University College of Medicine , Seoul , South Korea.
authors.forename: Jang Wook
authors.initials: JW
authors.lastname: Sohn
authors.affiliation: a Division of Infectious Diseases, Department of Internal Medicine , Korea University College of Medicine , Seoul , South Korea.
authors.forename: Min Ja
authors.initials: MJ
authors.lastname: Kim
authors.affiliation: a Division of Infectious Diseases, Department of Internal Medicine , Korea University College of Medicine , Seoul , South Korea.
authors.forename: Young Kyung
authors.initials: YK
authors.lastname: Yoon
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015505:Chest Tubes; D004697:Endocarditis, Bacterial; D006491:Hemothorax / Q000209:etiology* / Q000382:microbiology; D006801:Humans; D008297:Male; D013290:Streptococcal Infections; D013291:Streptococcus
chemical_list: D000900:Anti-Bacterial Agents
keywords: Haemothorax; Infective endocarditis; Pulmonary embolism; Streptococcus sanguinis