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Successful treatment, despite a non-surgical approach, of severe infective endocarditis

Peter K Boulos1, Mark Y Jeong

  • 1University of Colorado School of Medicine, Aurora, Colorado, USA.

BMJ Case Reports
|October 12, 2013
PubMed

Insights

This case report highlights effective medical management for infective endocarditis in a patient with cirrhosis. Intravenous nafcillin successfully resolved a large mitral valve vegetation without surgery.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Hepatology

Background:

  • Infective endocarditis poses significant risks, especially in patients with liver disease.
  • Child-Pugh class B cirrhosis complicates treatment decisions for infective endocarditis.
  • Surgical intervention for infective endocarditis in cirrhotic patients carries high perioperative risks.

Observation:

  • A 60-year-old male with Child-Pugh class B cirrhosis presented with symptoms of nausea, vomiting, and altered mental status.
  • Methicillin-sensitive Staphylococcus aureus bacteremia developed, leading to the discovery of a large mitral valve vegetation.
  • The patient was deemed a poor surgical candidate due to advanced cirrhosis.

Findings:

  • Medical management with 6 weeks of intravenous nafcillin was initiated.
  • Post-treatment echocardiography confirmed complete resolution of the mitral valve vegetation.
  • No significant valvular dysfunction was noted after treatment.

Implications:

  • Conservative medical management can be a viable alternative to surgery for infective endocarditis in select patients with cirrhosis.
  • This case underscores the importance of multidisciplinary evaluation in complex endocarditis cases.
  • Successful non-surgical treatment of infective endocarditis in cirrhotic patients is achievable.

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