亜急性ネイティブ弁感染性心内膜炎とその多発的合併症

Subacute Native Valve Infective Endocarditis and Its Multiple Complications.

• Jemimah Nallarajah
• M I Mujahieth

抄録

ネイティブ弁に感染性心内膜炎（IE）を引き起こすことは極めて稀であるが，静脈内薬物乱用者を中心に報告されており，免疫抑制，悪性腫瘍，人工心臓弁を含む弁膜症などの危険因子がある．薬物乱用者ではない58歳のスリランカ人男性に，尿量減少を伴う無痛性血尿を呈した在来型僧帽弁感染性心内膜炎の1例を報告した．入院中、彼は短い焦点性発作を頻繁に発症した。複数の検査を受けた結果，脾臓膿瘍，脳血管炎，糸球体腎炎が認められ，リウマチ因子，抗好中球細胞質抗体（C-ANCA），クライオグロブリンが陽性であった．適切な抗生物質の投与が治療の中心であり，予後は良好であった．この症例は血液培養に異常な細菌が存在したためにIEを発症したものであり，身体検査や調査が必要であった．

causing infective endocarditis (IE) in a native valve is an extremely rare event, but it is reported mostly in intravenous drug abusers and other risk factors as immunosuppression, malignancy, and valvular heart disease including prosthetic heart valves. We report a case of native mitral valve infective endocarditis in a 58-year-old Sri Lankan male who is not a drug abuser who presented with painless hematuria with reduced urine output. During hospital stay, he developed frequent episodes of brief focal seizures. He had undergone multiple investigations that revealed splenic abscesses, cerebral vasculitis, and glomerular nephritis with positive rheumatoid factor, cytoplasmic antineutrophil cytoplasmic antibody (C-ANCA), and cryoglobulin. The appropriate antibiotic was the prime therapeutic intervention which carried an excellent prognosis. This case highlights an unusual organism in the blood culture that caused IE warranting thorough physical examination and investigations.

Copyright © 2020 Jemimah Nallarajah and M. I. Mujahieth.