背景:右侧感染性心内膜炎,尤其是三尖瓣,是罕见且具有挑战性的诊断,通常表现为非特异性症状,并与高死亡率相关。此病例强调了管理此类疾病的复杂性以及早期诊断和多学科干预的重要性。
方法:本案例研究详述了一名34岁女性的病史,该女性有静脉吸毒背景。她随后患上了真菌性三尖瓣心内膜炎,导致植被的形成延伸到上腔静脉。手术切除后的质量为15×3cm。
结论:右侧感染性心内膜炎罕见,仅占5-10%的病例,三尖瓣心内膜炎更罕见。对内皮的损伤促进细菌附着,尤其是静脉吸毒者,金黄色葡萄球菌很常见。真菌性心内膜炎是罕见但致命的,死亡率高。诊断依赖于修改后的Duke标准,包括微生物和影像学证据.主要并发症影响瓣膜和全身区域。治疗p1rimarily涉及静脉抗生素,但持续性感染或严重并发症需要手术治疗.
结论:该病例强调了早期诊断和干预在治疗右侧感染性心内膜炎中的重要性,尤其是真菌病理学和具有复杂病史的患者。
BACKGROUND: Right-sided infective endocarditis, particularly of the tricuspid valve, is rare and challenging to diagnose, often presenting with nonspecific symptoms, and associated with high mortality rates. This
case underscores the complexities in managing such conditions and the importance of early diagnosis and multidisciplinary intervention.
METHODS: This
case study details the medical history of a 34-year-old woman who had a background of intravenous drug abuse. She subsequently developed a fungal tricuspid valve endocarditis, leading to the formation of vegetation that extended into the superior vena cava. The mass measured 15 × 3 cm upon surgical removal.
CONCLUSIONS: Right-sided infective endocarditis is rare, comprising only 5-10 % of cases, with tricuspid valve endocarditis being even rarer. Damage to the endothelium facilitates bacterial attachment, especially in IV drug users, with Staphylococcus aureus being common. Fungal endocarditis is rare but deadly, with high mortality. Diagnosis relies on the modified Duke criteria, including microbiological and imaging evidence. Major complications affect both valvular and systemic areas. Treatment p1rimarily involves IV antibiotics, but surgery is needed for persistent infections or severe complications.
CONCLUSIONS: This
case underscores the critical importance of early diagnosis and intervention in managing right-sided infective endocarditis, especially with a fungal pathology and in patients with complex medical histories.