单纯以发热为表现的亚急性感染性心内膜炎误诊分析及文献复习

摘要

Objective To explore the clinical characteristics, diagnosis and treatment of infectious endocarditis, and to reduce the misdiagnosis rate. Methods Clinical data of a patient with subacute infectious endocarditis in our hospital were retrospectively analyzed and related literatures were also reviewed. Results The 28-year-old female patient was admitted to hospital for prolonged low-grade fever for more than two months and with the past history of artificial abortion about one week before the onset. The patient had been diagnosed and received treatment in different local hospitals. She was examined with la-boratory and imaging testing in a local institution, but could not be definitively diagnosed. The patient received treatment of antibiotics and abatement of fever, but her symptoms had no mitigation. Upon admission to our hospital, the patient improved in all the relevant tests, and results appeared normal. Broad-spectrum antibiotics were administered for 3 day. The patient still had a fever. Clinicians suspended antibiotic therapy for 2 days for fear of suspected drug fever, but the patient's symptoms had no remission. Echocardiography was measured again and showed valve excrescence, valvular regurgitation. The repeated blood culture was streptococcus. So definite diagnosis of subacute infective endocarditis was made. After treatment of teicoplanin for 3 days, and the patient's temperature returned to normal. The patient was discharged 13 days after treatment. Conclusion The clinical manifestations of infectious endocarditis are diversified, and apt to be misdiagnosed. Clinicians should consider the disease when patients suffer from long-term low-grade fever but laboratory and imaging testing results are normal. In order to make accurate diagnosis of the disease, clinicians should focus on the heart valves when making echocardiography.%目的：探讨感染性心内膜炎( infectious endocarditis, IE)的临床特点、诊断及治疗方法,以降低误诊率。方法对1例亚急性IE患者的临床资料进行回顾性分析,并复习相关文献。结果本例为28岁女性,因反复低热2月余入院,发病前1周有人工流产史。曾于当地多家医院诊治,按发热原因待查、呼吸道感染等给予抗感染、退热对症处理,症状无明显缓解。收入院后完善各项医技检查亦无明显异常,予广谱抗生素治疗3 d,发热仍反复；怀疑药物热,停用抗生素2d仍无效。后经上级医师查房提醒再次复查心脏超声心动图提示心脏瓣膜有赘生物、瓣膜反流,心脏听诊有杂音,血液细菌培养有溶血性链球菌生长,确诊为亚急性IE。予替考拉宁治疗体温恢复正常,住院13 d病情好转出院。结论 IE临床表现多样易误诊,临床医师对常规实验室、影像学检查无特异性发现的长期不明原因反复低热患者应考虑本病可能,行心脏超声心动图检查重点观察瓣膜情况有助于本病确诊。