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The left atrial bacterial vegetative mass due to Corynebacterium striatum as a presentation of myxoma: a case report

机译:纹状体棒状杆菌引起的左房细菌营养性肿块为粘液瘤的表现:一例

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Background Corynebacterium striatum i s a member of the non-diphtherial corynebacteria, which are ubiquitous in nature and generally colonize the skin and mucous membranes of humans. Rarely, it causes infective endocarditis (IE). We report a case of rare left atrial bacterial vegetative mass due to C. striatum masquerading as a myxoma identified through a tortuous diagnostic process, and present a brief review of the relevant literature. Case presentation We present a case of 63-year-old man who presented with progressively worsening dyspnea on exertion and lower leg edema, and was diagnosed with heart failure. Transesophageal echocardiography (TEE) revealed that the left atrium was filled with a 2.7?cm?×?2.6?cm mass. The patient, who had no signs of infection or related risk factors, was suspected of having a left atrial myxoma clinically. After excising the mass, the histopathology suggested thrombus with no myxocytes. Postoperatively, a fever appeared and C. striatum was isolated from the blood cultures. Although antibiotics were used, the symptoms of heart failure worsened gradually and echocardiography revealed valve vegetation. The patient underwent a second operation because of IE. Surprisingly, the mass was confirmed to be a bacterial vegetation due to C. striatum based on Gram staining at a 1000× magnification, although this was not noted on routine pathological examination of the two surgical specimens. Conclusions Physicians should be aware of Corynebacterium in blood cultures, which cannot simply be assumed to be a contaminant. A diagnosis of IE should be suspected, particularly in high-risk patients or those with an unexplained fever. Our patient had IE due to C. striatum with no risk factors. This case supports the diagnosis of IE using a combination of pathology and etiology.
机译:背景技术纹状体棒状杆菌是非白喉棒状杆菌的成员,其本质上是普遍存在的,通常定植在人的皮肤和粘膜上。极少会引起感染性心内膜炎(IE)。我们报告了一例由于曲折诊断过程确定为粘液瘤的纹状体梭状芽孢杆菌引起的罕见的左心房细菌营养物质,并简要介绍了相关文献。病例介绍我们介绍了一例63岁的男性,该男性由于劳累和小腿浮肿而逐渐加重呼吸困难,并被诊断为心力衰竭。经食道超声心动图(TEE)显示左心房充满2.7?cm?×?2.6?cm的肿块。该患者无感染迹象或相关危险因素,临床上被怀疑患有左房粘液瘤。切除肿块后,组织病理学提示血栓无粘液细胞。术后出现发烧,从血液培养物中分离出纹状体梭状芽胞杆菌。尽管使用了抗生素,但心力衰竭的症状逐渐恶化,超声心动图检查发现瓣膜植被。由于IE,患者进行了第二次手术。出乎意料的是,尽管在两个手术标本的常规病理检查中都没有注意到,但根据革兰氏染色法,该肿块被证实是细菌纹状体,这是由革兰氏梭菌引起的,放大率为1000倍。结论医师应注意血液培养物中的棒杆菌,不能简单地将其假定为污染物。应该怀疑IE的诊断,尤其是在高危患者或发烧不明的患者中。我们的患者由于纹状体梭状芽胞杆菌而出现IE,无危险因素。此病例支持结合病理学和病因学对IE进行诊断。

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