Irina Niculescu 1, A. Cupşa 1, I. Diaconescu 1, L. Giubelan 1, Florentina Dumitrescu 1, Manuela Muşa 2, Ştefania Ionescu 2
1 U.M.F. Craiova
2 Spitalul de Boli Infecţioase şi Pneumoftiziologie „Victor Babeş”, Craiova
Abstract
Background: Infective endocarditis (IE), relatively uncommon disease could have a clinical presentation of sepsis and could be a clinical and therapeutic challenge. The tricuspid valve rarely is involved and audible heart murmurs may be absent in this case. Case presentation: We present the case of a 59 previously healty male, who visits ER for fever, productive cough, dyspnea and feet edema. Insidious onset (6 to 7 weeks previously) with asthenia, fever (started 1 to 2 weeks after the onset) Ten days later the patient (Px) becomes unconscious. Clinically: fever, palor, productive cough, polypnea, signs of right basal pneumonia, tachycardia (but no murmurs), feet edema, liver and spleen enlargements, lumbar pain and functio laesa of the left foot. Biologically: anemia, mild leukocytosis with 77% neutrophiles, increased ESR (107/120 mm/h), CRP detected in serum, 3 blood culture positive for Staphylococcus aureus. X-rays shows pneumonia. Treatment with Linesolid has no benefit. Examination of the heart using Doppler ultrasound reveals a tricuspidal 12 mm (then 18 mm) upgrowth. Vancomycin is the second choice for an antibiotic and then Oxacilin and the fever vanishes, blood cultures becomes negatives and clinical signs attenuates. Ten days after discharge Px underwent cardiac surgery for valvular prosthesis implant. Discussion: sepsis has been the foreground for a mute tricuspidal IE due to S. aureus, emerged in a normal host, representing a diagnostic riddle, as well as challenging the clinician about antibiotic options and case management.