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Infective endocarditis due to nasal septal perforation during home oxygen therapy

Kyota Shinfuku1, Naoki Takasaka1, Ryutaro Ohashi2

  • 1Division of Respiratory Diseases, Department of Internal Medicine The Jikei University Daisan Hospital Tokyo Japan.

Respirology Case Reports
|October 8, 2024
PubMed

Insights

Home oxygen therapy (HOT) can lead to nasal septal perforation, increasing the risk of severe Staphylococcus aureus infections like infective endocarditis. Proper nasal care during HOT is essential to prevent serious complications.

Area of Science:

  • Infectious Diseases
  • Pulmonology
  • Otolaryngology

Background:

  • Home oxygen therapy (HOT) is a common treatment for chronic respiratory conditions like interstitial pneumonia.
  • Nasal complications, including septal perforation, can arise from prolonged HOT due to mucosal dryness.
  • These nasal issues may serve as a portal for bacterial entry, leading to systemic infections.

Purpose of the Study:

  • To report a case of infective endocarditis (IE) secondary to nasal septal perforation in a patient undergoing HOT.
  • To highlight the potential link between nasal complications of HOT and severe bacterial infections.
  • To emphasize the importance of nasal care in patients receiving long-term oxygen therapy.

Main Methods:

  • Case report of a 64-year-old male patient with interstitial pneumonia on HOT.
  • Diagnosis of IE based on modified Duke criteria, including blood cultures and echocardiography.
  • Identification of Methicillin-sensitive Staphylococcus aureus (MSSA) in blood and nasal cavity cultures.
  • Clinical examination revealing nasal septal perforation.

Main Results:

  • The patient presented with dyspnea and was diagnosed with IE caused by MSSA.
  • Nasal septal perforation was identified as the likely entry point for MSSA.
  • Despite antibiotic treatment (cefazolin and clindamycin), the patient developed aspiration pneumonia and died.
  • MSSA colonization of the nasal cavity was confirmed.

Conclusions:

  • Nasal septal perforation, a complication of HOT, can lead to severe bacterial infections such as IE.
  • Damage to nasal mucosa from dryness and mucus removal during HOT facilitates bacterial invasion.
  • Vigilant nasal care is critical for patients on HOT to prevent serious infectious complications.
Keywords:
home oxygen therapyinfective endocarditisnasal septal perforation

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