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infective endocartitis

Posted By Cutberto M. Cortes Mr., Friday, August 19, 2016
Updated: Friday, August 19, 2016

The patient is a 53 years old female with the history of systemic arterial hypertension with 3 years of diagnosis, in treatment with ARB losartan 50 mg PO BID. End Stage Chronic Kidney Disease with 3 years of diagnosis, with no determined cause, with instalation of IJ central venous catheter on 13 June of 2016 and starting hemodialysis, 3 sessions per week. No other history of importance.

Initiating with malaise, fatigue, dyspnea and cough with sputum, 48 hours later after a hemodialysis session, initiating with unquantified fever on 07/20/2016. She is then hospitalized for in depth examination.

During hospitalization, it is registered low blood oxygen saturation being as low as 61%, a chest X-Ray is taken with an image compatible with a right basal consolidation. Relevant in Physical exploration is in posterior Thorax presence of crackles on the right inferior area. On the Anterior Thorax presence of a heart murmur III/VI on the tricuspid. Treatment with moxifloxacin is initiated. Routine blood tests are taken with results in results:

07/25/16: glucose 166 urea 128.9 creatinine 6.8 uric acid 9.1 albumin 1.87 Na 125.1 K 4.4 Ca 7.6 F 3.5 leukocites 32.12 neutrophils 26.6 Hb 6 VCM 89.5 MCHB 28.64 Platelets 167.5 procalcitonin >200.

Kidney USG: diffuse chronic changes associated with acute inflammatory process and increased diameter of urether on the left kidney.

Blood Cultures are taken with growth of Staph. Aureus methicillin sensible. The IJC was removed another was placed at femoral vein and continuing hemodialysis.

Ecocardiogram: left ventricle with 76% EF with alterations in diastole, aortic and mitral valves normal, adhered mass on the lateral part of the tricuspid ring and/or valve approximately 22x6 mm suggestive of vegetation. PSAP 42 mmHg (unfortunately no images were available). Diagnosing infective endocarditis and septic pulmonary embolism.

After an infectology consult, antibiotic treatment was changed to imipenem/cefalotin. Also a consult for thoracic surgery was made whom suggested a valve exchange due to the size of vegetation. There was no requirement of vasopressors.

Finally the patient was moved to the coronary unit and valve was exchanged. By the time patient has ben continuing hemodialysing throught femoral catheter. 

Pending the images

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