Enfektif endokardite sekonder gelişen multipl beyin apselerinin

Enfektif endokardite sekonder gelişen multipl beyin apselerinin

Enfektif endokardite sekonder gelişen multipl beyin apselerinin başarılı
tedavisi
Murat Yüksel, Mustafa Oylumlu, Abdulkadir Yıldız
Dicle Üniversitesi Tıp Fakültesi, Kardiyoloji Ad, Diyarbakır
Anahtar Kelimeler: Enfektif endokardit, kapak tamiri, septik emboli, beyin apsesi
Successful treatment of a case with multiple brain abscesses secondary to
infective endocarditis
Murat Yüksel, Mustafa Oylumlu, Abdulkadir Yıldız
Dicle University School Of Medicine, Cardiology Department, Diyarbakir
Key
words:
Infective
endocarditis,
valve
repair,
septic
emboli,
brain
abscess
Case
A 33-year-old male patient had symptoms of fever, vomiting, fatigue and right hemiparesis. His heart rate was
113 beats per minute and body temperature was 38.9°C. On auscultation, 3/6 systolic murmur was heard over
apical region. Transthoracic echocardiography revealed vegetations on both of the mitral valve leaflets and
accompanying severe mitral regurgitation. Transesophageal echocardiography showed 17x10 mm and 16x11
mm vegetations on atrial sides of mitral leaflets and accompanying severe mitral regurgitation (Figure 1).
Empirical ampicillin and gentamicin treatment was initiated. Cranial CT showed 3.0 cm and 3.5 cm hypodense
lesions on left parafalcine region and occipital lobes, respectively. Cranial MRI revealed multiple cortical and
subcortical lesions which were surrounded by hyper-intense edema zones (Figure 2). Staphylococcus aureus was
isolated from blood cultures and ampicillin was replaced with vancomycin. The patient underwent successful
mitral valve repair procedure with a ring annuloplasty (Figure 3) after 2 weeks of antibiotic treatment which was
continued for 4 weeks postoperatively. All symptoms resolved, including right hemiparesis, and follow-up MRI
revealed apparent regression of cranial lesions (Figure 4). The patient was discharged at the end of antibiotic
therapy and was asymptomatic at the 3rd month of follow-up. Appropriate antibiotic therapy and early valvular
surgery may reduce morbidity and mortality even accompanying neurological complications of infective
endocarditis.
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Figure Legends:
Figure 1. Depicts (A) vegetations (arrows) on both leaflets of the mitral valve and (B) accompanying severe
mitral regurgitation on transesophageal echocardiography
Figure 2. T2 weighted images on cranial MRI revealed multiple septic brain abscesses (arrows) located
subcortically
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Figure 3. Transesophageal view of the mitral apparatus free of vegetations after surgical repair with a ring at the
annulus
Figure 4. Follow-up cranial MRI demonstrated dramatically improved brain abscesses (arrows) 4 weeks after
the valvular surgery
.
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