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Published on: May 19, 2020
Postural instability revealing infective endocarditis secondary to severe mitral stenosis: A case report with
Raid Faraj1, Zaineb Bourouhou1, Houda Belhoussine1
1Department of Cardiology B, CHU Ibn Sina, Rabat, Morocco.
Introduction And Importance:
Infective endocarditis is a severe infection of the endocardial surface of the heart. One or more heart valves can be infected. However infective endocarditis complicating mitral stenosis is rare. It can be revealed by several and various symptoms such as fever and cardiac murmurs but also by complications such as focal neurological complaints.
Case Presentation:
We report a case of a febrile postural instability as the primary presentation of an infective endocarditis secondary to a severe mitral stenosis in a young patient with a history of mitral stenosis for which he benefited from percutaneous mitral dilation. The diagnosis was based on the modified Duke criteria. In this case, the treatment was based mainly on antibiotic therapy. The outcome was favorable; with a clinical, biological and radiological improvement. The patient was subsequently referred to the cardiovascular department for surgical treatment of his valve disease.
Clinical Discussion:
Rheumatic heart disease is the main cause of mitral stenosis and its prevalence is higher in developing nations than in the rest of the world, yet only few articles have reported infective endocarditis as a complication of mitral stenosis.
Conclusion:
Mitral stenosis is rarely complicated by infective endocarditis, but this diagnosis should not be excluded in developing countries, particularly because of its high prevalence. To that end, clinicians should recognize its symptoms and complications and act accordingly to allow early treatment.
Insights
Infective endocarditis complicating mitral stenosis is rare but crucial to diagnose, especially in developing nations. Early recognition of symptoms and prompt treatment are vital for favorable outcomes in patients with mitral stenosis.
Area of Science:
- Cardiology
- Infectious Diseases
Background:
- Infective endocarditis (IE) is a serious heart valve infection.
- Mitral stenosis (MS), often due to rheumatic heart disease, is a risk factor for IE.
- IE complicating MS is uncommon but reported, particularly in developing countries.
Observation:
- A case of a young patient with severe mitral stenosis presented with febrile postural instability.
- Diagnosis of infective endocarditis was confirmed using modified Duke criteria.
- Treatment primarily involved antibiotic therapy, leading to positive clinical, biological, and radiological outcomes.
Findings:
- This case highlights febrile postural instability as a potential primary symptom of IE in MS.
- Successful management with antibiotics underscores the importance of early diagnosis and intervention.
- The patient required subsequent surgical management for the underlying valve disease.
Implications:
- Clinicians must maintain a high index of suspicion for IE in patients with MS, especially in high-prevalence regions.
- Prompt diagnosis and treatment of IE in MS can lead to favorable outcomes.
- This case emphasizes the need for integrated cardiovascular and infectious disease management.
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