Lesson of the month 2: When steroids stop working – infective endocarditis, the great mimicker
Autor: | James S Tomlinson, Alberto San Francisco, Sally Curtis, Samuel Walters, Rachael James |
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Rok vydání: | 2019 |
Předmět: |
Male
medicine.medical_specialty Aortic Valve Insufficiency Giant Cell Arteritis 030204 cardiovascular system & hematology Malaise 03 medical and health sciences 0302 clinical medicine Aortic valve replacement Adrenal Cortex Hormones Streptococcal Infections Internal medicine medicine Humans Endocarditis Treatment Failure 030212 general & internal medicine Lesson of the Month Asia Southeastern Travel business.industry Streptococcus Endocarditis Bacterial General Medicine Middle Aged medicine.disease Rheumatology Surgery Giant cell arteritis Infective endocarditis Prednisolone medicine.symptom Headaches business Echocardiography Transesophageal medicine.drug |
Zdroj: | Clinical Medicine. 19:82-84 |
ISSN: | 1473-4893 1470-2118 |
Popis: | A 63-year-old man with an extensive travel history to South East Asia presented with generalised malaise, temporal headaches and high inflammatory markers. He was treated with corticosteroids for presumed giant cell arteritis. Unsuccessful attempts to wean him from prednisolone prompted further investigations by rheumatology, haematology and finally ophthalmology. Roth spots were identified which prompted blood cultures to be taken. All three sets grew Streptococcus sinensis, an alpha-haemolytic Streptococcus reported as an emerging cause of endocarditis worldwide. The patient had signs of severe aortic regurgitation, confirmed on transthoracic echo. A transoesophageal echo demonstrated large aortic valve vegetations. He underwent an aortic valve replacement and completed 6 weeks of intravenous antibiotics with resolution of his symptoms. This case illustrates the importance of challenging a previous diagnosis, including repeat examination, when a patient’s condition does not evolve as expected. Endocarditis is recognised as a great imitator and the diagnosis remains challenging. |
Databáze: | OpenAIRE |
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