若い健康な患者の積極的な心内膜炎。症例報告

Aggressive Endocarditis in a Young Healthy Patient: A Case Report.

• Steven Douedi
• Vandan D Upadhyaya
• Aref Obagi
• Mohammad Hossain

抄録

()は、β溶血性コアグラーゼ陰性ブドウ球菌で、皮膚・軟部組織感染症の発生率が増加している。一般的には肛門周囲の正常な細菌叢として発見されているが，まれに感染性心内膜炎の症例でも発見され，罹患率と死亡率の上昇を引き起こしている．我々は、以前は健康だった若い男性が感染性心内膜炎を発症した症例を紹介する。31歳の男性で既往歴はなく，1週間にわたる発熱性疾患と倦怠感の後，急性発症の圧迫性下胸部圧迫と呼吸困難，深部発汗を呈して救急外来を受診した．最初の心電図（心電図）はすべての心前導線にびまん性のST低下を示し，急性冠症候群と一致していた．緊急時の経胸腔心エコー図では駆出率（EF）は45％であり，右冠状動脈尖端部の断裂を伴う重度の大動脈不全を呈していた．心停止し，13分後に自然循環回復（ROSC）が得られた．その後、機械的大動脈弁置換術を受けた。大動脈弁の原生培養物が増殖していた。術後、抗生物質の長期投与後、患者は合併症もなく完全に回復した。我々はこの症例発表が、.感染性心内膜炎が疑われる患者の緊急弁置換術をサポートすることを願っています。

() is a β-hemolytic coagulase-negative staphylococcus causing skin and soft tissue infections with an increasing incidence. Commonly found as normal flora in the perineal region, has been found in rare cases of infective endocarditis causing increased morbidity and mortality. We present a case of a previously healthy young male diagnosed with -caused infective endocarditis. A 31-year-old male with no significant past medical history, who presented to the emergency department with acute onset crushing substernal chest pressure and dyspnea with profuse sweating following 1-week-long febrile illness and malaise. The initial electrocardiogram (ECG) showed diffuse ST depressions in all precordial leads, consistent with an acute coronary syndrome. Emergent transthoracic echocardiogram revealed an ejection fraction (EF) of 45% with severe aortic insufficiency with emanating from a torn right coronary cusp. The patient had a cardiac arrest, and recovery of spontaneous circulation (ROSC) was obtained after 13 min. He subsequently underwent mechanical aortic valve replacement surgery. The native valve specimen cultures grew . . Postoperatively and after a long course of antibiotics, the patient fully recovered without complications. is a common organism with increasing incidence that can lead to significant morbidity and mortality if not properly detected and treated. We hope this case presentation would support emergency valve replacement surgery in patients with . -suspected infective endocarditis.

Copyright 2020, Douedi et al.