多微生物性心内膜炎很少见,但见于那些有糖尿病等危险因素的患者,结构性心脏病,先天性心脏缺陷,假肢装置,和静脉注射毒品。我们报告了一名30岁的女性,其既往有慢性丙型肝炎和IV药物使用史,具有一周的全身性虚弱史,主观发烧,下肢脓肿,偶尔还有胸痛.血培养阳性的链球菌,Gemella血溶素,还有铜绿假单胞菌.经胸超声心动图显示三尖瓣生长非常大,三尖瓣反流严重。她的课程因完整的心脏传导阻滞而变得复杂,脓毒性肺栓塞,急性低氧性呼吸衰竭,和心源性休克符合早期手术干预的标准。她接受了紧急三尖瓣置换术和起搏器植入。在操作过程中,很明显,她的瓣膜被植被破坏了。手术一周后,她的射血分数提高至50%,仅表现为轻度三尖瓣反流.六周后,她情况稳定,接受随访。近50%的Gemella心内膜炎病例需要手术,62%的病例与心绞痛组,和大约56%的铜绿假单胞菌病例。据我们所知,这是唯一由G.hemolysans引起的多微生物性心内膜炎,S.anginosus,还有铜绿假单胞菌.
Polymicrobial endocarditis is rare but is seen in those with risk factors like diabetes mellitus, structural heart disease, congenital heart defects, prosthetic devices, and intravenous drug use. We report the case of a 30-year-old woman with a past medical history of chronic Hepatitis C and IV drug use who presented with a one-week history of generalized weakness, subjective fevers, lower extremity abscesses, and occasional chest pain. Blood cultures were positive for Streptococcus anginosus, Gemella hemolysans, and Pseudomonas aeruginosa. A transthoracic echocardiogram revealed a very large tricuspid valve vegetation and severe tricuspid regurgitation. Her course was complicated by a complete heart block, septic pulmonary emboli, acute hypoxic respiratory failure, and cardiogenic shock meeting the criteria for early surgical intervention. She underwent an emergency tricuspid valve replacement and pacemaker implantation. During the operation, it became evident that her valve was destroyed with vegetation. A week after the operation, her ejection fraction had improved to 50% and she only exhibited mild tricuspid valve regurgitation. Six weeks later, she was in a stable condition and presented for follow-up. Surgery is necessitated in nearly 50% of Gemella endocarditis cases, 62% of cases with S. anginosus group, and approximately 56% of P. aeruginosa cases. To our knowledge, this is the only case of polymicrobial endocarditis caused by G. hemolysans, S. anginosus, and P. aeruginosa.