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静脉注射药物使用者与精神病史中的大动脉内心炎:一个诊断挑战

Fnu Samaksh¹, Kesar Prajapati¹, Poornima Jaiswal Charpuria¹

¹Internal Medicine, New York Medical College, Metropolitan Hospital Center, New York, USA.

|April 21, 2025

概括

在无发烧患者中,诊断感染性内心炎 (IE) 是具有挑战性的,特别是那些静脉注射药物使用 (IVDU) 患者. 这一案例凸显了非典型表现的心声回声学的必要性,以确保对这种严重的心脏感染及时治疗.

科学领域:

心脏病学心脏病学
传染性疾病传染性疾病
精神病学是一个精神病学.

背景情况:

传染性内心炎 (IE) 是一种严重的心脏感染,常常伴有发烧等经典症状.
异常呈现的IE可以显著延迟诊断和治疗.
高风险人群,包括静脉注射药物使用者 (IVDU),存在独特的诊断挑战.

研究的目的:

在患有精神疾病和IVDU病史的患者中呈现一种具有挑战性的培养负性传染性内心炎病例.
强调在异常症状和风险因素的患者中考虑IE的重要性.
要突出回声心脏学在诊断IE当经典症状缺席时的作用.

主要方法:

一个45岁的男性患有精神分裂症和IVDU的病例报告,呈现出自杀念头.
临床检查显示出高心率,脚踏 edem,支气管呼吸声音,和一个透气声.
诊断工作包括心声回声,它确定了大动脉植被和减少喷射分数.

主要成果:

患者接受了紧急的大动脉置换和左心房附属体剪切.
尽管切除膜培养和格拉姆染色结果呈阴性,但强烈怀疑IE.
手术后进行了为期六周的抗生素疗程.

结论:

发烧,培养负的IE带来了诊断困境,可能是由于先前的抗生素使用或苛刻的生物体.
精神病症状可以掩盖典型的IE症状,需要高临床怀疑指数.
综合评估,包括心声回声,对于早期诊断和复杂IE病例的改善结果至关重要.

关键词:

大动脉膜疾病声心成像 - - 心力衰竭 - - 膜心脏病传染性内心炎是一种感染性内心炎.静脉注射药物使用 (IVDU)精神分裂症是一种精神分裂症.

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