背景:与医疗相关的心内膜炎是一种罕见且严重的疾病。由于免疫抑制和不同类型的血管通路的多样性,血液透析患者发生的风险增加。启示的方式可以是可变的,因为它引起的症状的多样性。在这里,我们描述了一例出现神经系统症状的肾衰竭患者与医疗相关的心内膜炎病例.
方法:一名38岁的患者,在血液透析阶段有肾脏疾病史,在发烧的情况下出现神经系统状态改变,被送往急诊室。病人的情况需要气道控制,镇静,和血管加压药.脑成像显示Fisher4蛛网膜下腔出血伴脑胀。经胸和经食道心脏超声探查显示,感染性线粒体-主动脉心内膜炎伴左心室三角脓肿,主动脉瓣破坏伴大量反流。第二步中的附加成像没有突出显示任何霉菌性动脉瘤的图像。由于经颅多普勒超声显示血流动力学不稳定和脑内血流动力学不良,因此未批准早期手术的指征。抗生素治疗和肾脏替代的初始结果是有利的。但是由于感染性休克伴多器官衰竭,随后的过程是致命的。
结论:在出现有全身受累迹象的脓毒症状态的血液透析患者中,应始终考虑感染性心内膜炎的诊断。它是这些衰弱患者的死亡来源。
BACKGROUND: Endocarditis associated with medical care is a rare and serious entity. The risk of occurrence is increased in hemodialysis patients due to the immunosuppression and the multiplicity of vascular accesses of different kinds. The mode of revelation can be variable given the diversity of symptoms it causes. Herein, we describe the
case of endocarditis associated with medical care in a patient with renal failure who presents with neurological symptoms.
METHODS: A 38-year-old patient with a history of kidney disease in the hemodialysis stage presented to the emergency room with altered neurological status in the context of fever. The patient\'s condition requires airway control, sedation, and vasopressor medication. Brain imaging revealed Fisher 4 subarachnoid hemorrhage with brain turgor. Transthoracic and transesophageal cardiac ultrasound exploration revealed infective mitro-aortic endocarditis with trigonal abscess fistulized in the left ventricle and destruction of the aortic valve with massive regurgitation. The additional imaging in a second step did not highlight any images of mycotic aneurysm. The indication for early surgery was not approved given the hemodynamic instability and the poor intracerebral hemodynamics demonstrated by transcranial doppler ultrasound. The initial outcome under antibiotic treatment and renal replacement was favorable. But the subsequent course was fatal due to septic shock with multiple organ failure.
CONCLUSIONS: The diagnosis of infective endocarditis should always be considered in hemodialysis patients presenting in a septic state with signs of systemic involvement. It is a source of mortality in these debilitated patients.