背景:孤立性肺动脉瓣心内膜炎(IPE)占所有感染性心内膜炎患者的不到2%。它通常与几个诱发因素有关,包括静脉吸毒(IVDU)和先天性心脏病。IPE最常见的致病病原体是金黄色葡萄球菌和草绿色链球菌。我们报告了一名患有IPE的唐氏综合征患者,没有由罕见病原体不动杆菌属引起的标准危险因素。由于化脓性肺栓塞,这会导致呼吸衰竭和全身感染。由于患者不再对药物治疗有反应,因此决定进行早期择期手术。随着时间的推移,他的临床状况正在恶化。
方法:一名15岁男性,患有唐氏综合征,没有潜在的心脏缺陷,有3个月的发作性发热史,恶心,呕吐,和腹泻。经胸超声心动图(TTE)显示肺动脉瓣小叶上有大量植被,肺动脉分叉处的另一个移动肿块,和严重的肺反流.连续血液培养分离的不动杆菌属。尽管最初的抗生素治疗,病人继续有败血症,未解决的植被,并出现危及生命的并发症和呼吸窘迫,说服我们用同种异体移植进行肺动脉瓣置换手术。手术后,患者康复并在术后第9天(POD)出院。
结论:本报告重点介绍了IPE的诊断和治疗挑战,除了对无法解释的发烧患者进行全面的心肺检查的重要性,脓毒症,和肺部症状,即使没有典型的危险因素。根据患者的病情加重,尽管接受了治疗,早期手术干预和肺动脉瓣置换术被认为至关重要.然而,对于复杂的IPE患者,何时以及如何进行手术仍需要明确的指南,尤其是儿科患者。
BACKGROUND: Isolated pulmonary valve endocarditis (IPE) accounts for less than 2% of all infective endocarditis patients. It is commonly associated with several predisposing factors, including intravenous drug use (IVDU) and congenital heart disease. The most common causative pathogens of IPE are Staphylococcus aureus and Streptococcus viridans. We report a Down\'s syndrome patient with IPE and with no standard risk factors caused by the rare pathogen Acinetobacter spp. This led to respiratory failure and systemic infection due to septic pulmonary emboli. Early elective surgery was decided upon as the patient was no longer responding to medical therapy, and his clinical condition was worsening over time.
METHODS: A 15-year-old male with Down syndrome and no underlying heart defect presented with a 3-month history of episodic fever, nausea, vomiting, and diarrhea. Transthoracic echocardiography (TTE) revealed large vegetation on the pulmonary valve leaflet, another mobile mass at the pulmonary artery bifurcation, and severe pulmonary regurgitation. Serial blood cultures isolated Acinetobacter spp. Despite initial antibiotic therapy, the patient continued to have sepsis, unresolved vegetations, and developed life-threatening complications and respiratory distress, which convinced us to perform a pulmonary valve replacement surgery with a homograft. After surgery, the patient recovered and was discharged on the ninth postoperative day (POD).
CONCLUSIONS: This report highlights IPE\'s diagnostic and therapeutic challenges, alongside the importance of a comprehensive cardiopulmonary workup in patients with unexplained fever, sepsis, and pulmonary symptoms, even without typical risk factors. Based on the patient\'s aggravating condition despite medical treatment, early surgical intervention and pulmonary valve replacement were deemed crucial. However, there still needs to be a definitive guideline on when and how surgery should be performed in patients with complicated IPE, especially in pediatric patients.