دورية
The changing face of endocarditis: report of a series of cases
| العنوان: | The changing face of endocarditis: report of a series of cases |
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| المؤلفون: | Brydie, Alan D, Clark, Andrew L |
| المصدر: | British Journal of Hospital Medicine; May 1999, Vol. 60 Issue: 5 p378-380, 3p |
| مستخلص: | A 67-year-old man presented with a sudden onset right homonymous hemianopia associated with a swinging pyrexia and a new early diastolic parasternal murmur. He had had a Bjork–Shiley aortic valve replacement 2 years previously for symptomatic aortic stenosis with a transvalvular gradient of 80 mmHg and had been well thereafter.Computed tomography scan of the brain showed a left occipital infarct (Figure 1), C-reactive protein was 51 mg/litre (normal <10 mg/litre), blood cultures consistently grew Candida parafilaris, and treatment with intravenous liposomal amphotericin and flucytocine was started the day the first positive culture was obtained. Transoesophageal echocardiography did not demonstrate vegetations, but did show a periprosthetic aortic incompetent leak.On day 11 the aortic prosthesis was removed and replaced because of worsening aortic incompetence. Direct inspection of the prosthesis demonstrated a vegetation on the sewing ring. The immediate postoperative recovery period was complicated by complete heart block requiring insertion of a permanent pacemaker after an initial phase of pericardial pacing.The intravenous antifungals were discontinued after 37 days of treatment and the patient commenced on lifelong oral fluconazole. At discharge on day 42 the patient was well and apyrexial with C-reactive protein less than 10 mg/litre. |
| قاعدة البيانات: | Supplemental Index |
| تدمد: | 17508460 17597390 |
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| DOI: | 10.12968/hosp.1999.60.5.1122 |