Infective endocarditis with left to right intracardiac fistula due to\ud Streptococcus anginosus - a rare complication caused by an even rarer bacterium

摘要

Although infective endocarditis (IE) has been described in reports dating\udfrom the Renaissance, the diagnosis still challenges and the outcome often\udsurprises. In the course of time, diagnostic criteria have been updated and\udvalidated to reduce misdiagnosis. Some risk factors and epidemiology have\udshown dynamic changes since degenerative valvular disease became more\udpredominant in developed countries, and the mean age of the affected\udpopulation increased. Despite streptococci have been being well known as\udetiologic agents, some groups, although rare, have been increasingly reported\ud(e.g., Streptococcus milleri.) Intracardiac complications of IE are common and\udhave a worse prognosis, frequently requiring surgical treatment. We report a\udcase of a middle-aged diabetic man who presented with prolonged fever, weight\udloss, and ultimately severe dyspnea. IE was diagnosed based on a new valvular\udregurgitation murmur, a positive blood culture for Streptococcus anginosus, an\udechocardiographic finding of an aortic valve vegetation, fever, and pulmonary\udthromboembolism. Despite an appropriate antibiotic regimen, the patient died.\udAutopsy findings showed vegetation attached to a bicuspid aortic valve with an\udassociated septal abscess and left ventricle and aortic root fistula connecting\udwith the pulmonary artery. A large thrombus was adherent to the pulmonary\udartery trunk and a pulmonary septic thromboemboli were also identified.