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[Infective Endocarditis Diagnosed After Acute Arterial Occlusion of the Lower Extremity:Report of a Case]
Naoto Yabu1, Tomoyuki Minami, Aya Tateishi
1Department of Cardiovascular Surgery, Fujisawa City Hospital, Fujisawa, Japan.
Insights
A patient with bilateral acute arterial occlusion of the lower extremity developed infective endocarditis. Prompt diagnosis and surgical intervention, including mitral valve replacement, led to successful recovery and no infection recurrence.
Area of Science:
- Vascular Surgery
- Infective Endocarditis
- Cardiovascular Medicine
Background:
- Bilateral acute arterial occlusion of the lower extremity presents a significant clinical challenge.
- Infective endocarditis can lead to severe embolic complications, impacting multiple organ systems.
Purpose of the Study:
- To report a case of bilateral acute arterial occlusion of the lower extremity secondary to infective endocarditis.
- To highlight the importance of investigating persistent fever in patients with arterial occlusion.
Main Methods:
- Contrast-enhanced computed tomography (CT) for diagnosis of arterial occlusion.
- Echocardiography for detection of valvular vegetations.
- Emergency thrombectomy and subsequent mitral valve replacement.
Main Results:
- Successful restoration of arterial blood flow after thrombectomy.
- Diagnosis of infective endocarditis with embolic complications confirmed by echocardiography.
- Complete resolution of infection following mitral valve replacement and antibiotic therapy.
Conclusions:
- Infective endocarditis should be considered in the differential diagnosis of acute arterial occlusion, especially with persistent fever.
- Multidisciplinary management involving vascular surgery and cardiology is crucial for optimal outcomes.
- Early surgical intervention for valvular complications in infective endocarditis can prevent recurrence and improve prognosis.
Abstract:
A 73-year-old male was admitted to our hospital due to fever and right lower limb pain. Contrast-enhanced computed tomography (CT) revealed occlusion from the right common femoral artery to the right superficial femoral artery and from the left common iliac artery to the left internal and external iliac arteries, leading to a diagnosis of bilateral acute arterial occlusion of the lower extremity. Emergency thrombectomy was performed to improve arterial blood flow. However, the patient continued to experience persistent fever and blood culture results were positive, prompting further investigation for the source of infection. Echocardiography revealed vegetations on the mitral valve and infective endocarditis with embolic complications was diagnosed. Because of the presence of residual vegetation, urgent mitral valve replacement was performed. The patient experienced no recurrence of infection postoperatively and was discharged home on continued oral antibiotic therapy.
