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Mitral Valve Infective Endocarditis Associated With Prednisolone-Induced Immunosuppression: A Case Report
Tomohiro Nakajima1, Yutaka Iba1, Tsuyoshi Shibata1
1Cardiovascular Surgery, Sapporo Medical University, Sapporo, JPN.
Abstract:
A 74-year-old man with pemphigoid, for which he was on a daily regimen of 14 mg of prednisolone and immunosuppressive drugs, was admitted to the orthopedic surgery department with a fever of 38 °C. An MRI scan of his head revealed multiple bilateral cerebral infarcts, and echocardiography showed a 30-mm structure attached to the anterior apex of the mitral valve. The patient was diagnosed with infective endocarditis and administered antibiotic therapy. Five days after the diagnosis, the patient underwent mitral valve surgery, during which the mitral valve was observed to be severely deteriorated and hence replaced with a bioprosthetic valve. Blood flow disturbance was observed in the right lower extremity, and a thrombectomy was performed. A dispersed vegetation around the heart was observed and removed. After the surgery, the patient progressed without mediastinitis and had a good postoperative course. He was discharged from the hospital on the 56th postoperative day after continued antibiotic therapy.
Insights
A 74-year-old man developed infective endocarditis, leading to mitral valve replacement and treatment for cerebral infarcts and leg blood flow issues. Prompt medical intervention ensured a good recovery.
Area of Science:
- Cardiology
- Infectious Diseases
- Neurosurgery
Background:
- A 74-year-old male patient with pemphigoid, on prednisolone and immunosuppressants, presented with fever.
- Immunosuppression can increase susceptibility to serious infections.
Observation:
- Cerebral MRI revealed multiple bilateral infarcts.
- Echocardiography identified a 30-mm mass on the mitral valve anterior apex.
- Physical examination indicated blood flow disturbance in the right lower extremity.
Findings:
- The patient was diagnosed with infective endocarditis.
- Mitral valve surgery was performed, revealing severe deterioration and necessitating bioprosthetic valve replacement.
- Thrombectomy was conducted for the lower extremity blood flow issue.
- Dispersed cardiac vegetation was removed.
Implications:
- Early diagnosis and surgical intervention are crucial for managing infective endocarditis.
- Multidisciplinary care involving cardiology, infectious diseases, and surgery is vital for complex cases.
- Successful treatment of infective endocarditis can prevent severe complications like stroke and limb ischemia.
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