Complicated Infective Endocarditis: A Case Series

Joo Seop Kim; Min-Kyung Kang; A. Jin Cho; Yu Bin Seo; Kun Il Kim

Disclosures

J Med Case Reports. 2017;11(128) 

In This Article

Discussion

IE is associated with cardiac, neurologic, renal, and musculoskeletal complications. Predisposing factors include the infecting pathogen, duration of illness prior to therapy, and underlying comorbidities.[1] IE caused by S. aureus is associated with complications more frequently than other pathogens.[5]

MA can develop in the cerebral or systemic circulation in the setting of IE,[6] and cerebral hemorrhage caused by stroke or a ruptured MA can cause neurologic complications. Direct bacterial inoculation, bacteremic seeding, contiguous infection, and septic emboli are the sources of MA. Intracranial MA usually involves more distal portions of the middle cerebral artery, as in patient 1, and unruptured aneurysms may be managed with antibiotics alone. However, ruptured aneurysms should be managed with a combination of antibiotics and surgery.[6] Patient 1 developed intracranial hemorrhage and a seizure; we initially attempted conservative treatment with EVD and close monitoring in the intensive care unit, and then we performed a redo MVR after stabilization.[4] The perioperative mortality rate for infected aortic aneurysms is 15% to 20%.[7] Survival is better for an infrarenal abdominal aortic aneurysms than for noninfrarenal aneurysms (96% versus 57%, respectively).[8] Therefore, we suggest debridement of an infected infrarenal aortic aneurysm, along with extraanatomic reconstruction. The guardians of patient 2 refused all surgery because of the high morbidity and mortality risk.

In contrast to relatively common splenic infarctions in patients with embolic events, splenic abscesses are very rare and fatal complications of IE.[3] The treatments of choice are antibiotics, splenectomy, and valve replacement surgery. After patient 3 was stabilized with drainage of a splenic abscess, we decided to perform valve replacement surgery and debridement of the perforated intracardiac abscess pocket. The aortic and mitral valves were relatively clean, except for degenerative changes, but infected thrombi were noted in a phlegmon.

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