The Brief Case: Scopulariopsis Endocarditis—a Case of Mistaken Takayasu's Arteritis

摘要

A 37-year-old Japanese woman with a past medical history of aortic valve replacement secondary to a congenital aortic aneurysm and presumed Takayasu's arteritis treated with prednisone (60 mg daily) presented to the inpatient service with shortness of breath, abdominal pain, and leg and foot pain. The patient had a 9-month history of repeated emboli and fevers. Due to the concern for an unidentified source of the emboli, a computed tomography angiography (CTA) of the chest was conducted, revealing a moderately sized pseudoaneurysm arising from the posterior margin of a previously performed ascending aortic graft and filling defects concerning for thrombi in the distal ascending aorta/proximal aortic arch near the graft anastomosis. The patient was started empirically on broad-spectrum antimicrobials consisting of intravenous vancomycin (750 mg every 12 h [q12h]), piperacillin-tazobactam (3.37 g q8h), and voriconazole (200 mg q12h).