[Diagnostic problems in a patient with staphylococcal endocarditis]

A patient, aged 68, admitted to the Internal Medicine Ward, in connection with syncope and a persisting fever which had appeared for the third time during the last two months. The patient had an artificial aortic valve graft implanted and a heart bypass surgery (CAPG) in 1994. A urine examination, performed before his admission to hospital, showed the characteristic changes which appeared in UTI (urine tract infection). Then the patient was treated with quinolone (zanocin) and the abatement of the fever was achieved. After two weeks the recurrence of the intermittent fever appeared. The diagnosis of bacterial endocarditis was established and a broad spectrum antibiotic treatment was introduced and continued in spite of the negative blood culture. The circulatory failure and growing cachexia developed in the patient and led to his death within two weeks. From the last blood sample Staphylococcus aureus was cultured. In autopsy the phlegmonic and haemorrhagic changes were found, with foci of necrosis in the region of the implanted artificial valve graft. Some changes of the type of interstitial numerous, microfocal, phlegmonic foci were also found. The author drew the conclusion that if the treatment with broad spectrum antibiotics had been introduced, in the patient with a fever, after a heart surgery, there would have been a chance for the successful treatment.