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Infective endocarditis presents as isolated splenomegaly.

Rohani A, Akbari V, Homayoon K - J Cardiovasc Dis Res (2011)

Bottom Line: Sub acute left-sided bacterial endocarditis is a serious condition that may be overlooked due to highly variable clinical manifestations.We present the case of a 45-year-old man who presented with complaints of fullness in his abdomen and splenomegaly that referred to the surgery clinic.We recommend echocardiography in the work up of isolated splenomegaly.

View Article: PubMed Central - PubMed

Affiliation: Yasuj University of Medical Science, Motahari st, Yasuj, Iran.

ABSTRACT
Sub acute left-sided bacterial endocarditis is a serious condition that may be overlooked due to highly variable clinical manifestations. We present the case of a 45-year-old man who presented with complaints of fullness in his abdomen and splenomegaly that referred to the surgery clinic. He underwent diagnostic splenectomy. 3 month after splenectomy endocarditis was diagnosed. We recommend echocardiography in the work up of isolated splenomegaly.

No MeSH data available.


Related in: MedlinePlus

Aortic valve vegetation
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Figure 1: Aortic valve vegetation

Mentions: A workup of the patient was initiated. A complete blood cell count, chest X-ray, liver enzymes examination, thyroid function test, malaria smear, kala-azar, infectious mononucleosis Ab, anti-nuclear factor, Coomb's test, blood cultures, Serology for HIV, hepatitis and other infections, electrocardiogram, and urinalysis all showed normal findings. Only rheumatoid factor was positive. Electrolytes and creatinine were normal. Abdominal sonography was performed and it was normal (no portal hypertension, splenic or portal vein thrombosis) except for splenomegaly. MRI Chest/Abdomen, upper GI endoscopy was performed and was normal. A bone marrow aspiration and biopsy was done for him, which was normal. Because of progressively enlarged splenomegaly, the patient underwent diagnostic splenectomy. In pathology examination, no specific finding or abscess was noted. The patient was discharged though he did not feel well. Three months after splenectomy, the patient had chest pain and was referred to a cardiologist. On physical examination, the patient appeared asthenic; he had a grade 3/6 diastolic murmur in the aortic area and conjunctival haemorrhage. Two-dimensional echocardiography was done and showed oscillating hypermobile mass (vegetation) on aortic valve and severe aortic regurgitation [Figure 1]. Coronary angiography was normal; patient was referred to a cardiac surgeon. Blood cultures were negative. Our patient presented with one major criterion and three minor criteria, thus satisfying the Duke criteria [2] for definite endocarditis. An emergency operation was performed after the diagnosis. Findings at operation included phlegmon on the aortic valve leaflets with anterior leaflet perforation. The valve was replaced with a St Jude prosthetic valve. The patient was discharged from the hospital after he recovered well from surgery. In the culture of the valve, Streptococcus viridans was present [Figure 2].


Infective endocarditis presents as isolated splenomegaly.

Rohani A, Akbari V, Homayoon K - J Cardiovasc Dis Res (2011)

Aortic valve vegetation
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3120277&req=5

Figure 1: Aortic valve vegetation
Mentions: A workup of the patient was initiated. A complete blood cell count, chest X-ray, liver enzymes examination, thyroid function test, malaria smear, kala-azar, infectious mononucleosis Ab, anti-nuclear factor, Coomb's test, blood cultures, Serology for HIV, hepatitis and other infections, electrocardiogram, and urinalysis all showed normal findings. Only rheumatoid factor was positive. Electrolytes and creatinine were normal. Abdominal sonography was performed and it was normal (no portal hypertension, splenic or portal vein thrombosis) except for splenomegaly. MRI Chest/Abdomen, upper GI endoscopy was performed and was normal. A bone marrow aspiration and biopsy was done for him, which was normal. Because of progressively enlarged splenomegaly, the patient underwent diagnostic splenectomy. In pathology examination, no specific finding or abscess was noted. The patient was discharged though he did not feel well. Three months after splenectomy, the patient had chest pain and was referred to a cardiologist. On physical examination, the patient appeared asthenic; he had a grade 3/6 diastolic murmur in the aortic area and conjunctival haemorrhage. Two-dimensional echocardiography was done and showed oscillating hypermobile mass (vegetation) on aortic valve and severe aortic regurgitation [Figure 1]. Coronary angiography was normal; patient was referred to a cardiac surgeon. Blood cultures were negative. Our patient presented with one major criterion and three minor criteria, thus satisfying the Duke criteria [2] for definite endocarditis. An emergency operation was performed after the diagnosis. Findings at operation included phlegmon on the aortic valve leaflets with anterior leaflet perforation. The valve was replaced with a St Jude prosthetic valve. The patient was discharged from the hospital after he recovered well from surgery. In the culture of the valve, Streptococcus viridans was present [Figure 2].

Bottom Line: Sub acute left-sided bacterial endocarditis is a serious condition that may be overlooked due to highly variable clinical manifestations.We present the case of a 45-year-old man who presented with complaints of fullness in his abdomen and splenomegaly that referred to the surgery clinic.We recommend echocardiography in the work up of isolated splenomegaly.

View Article: PubMed Central - PubMed

Affiliation: Yasuj University of Medical Science, Motahari st, Yasuj, Iran.

ABSTRACT
Sub acute left-sided bacterial endocarditis is a serious condition that may be overlooked due to highly variable clinical manifestations. We present the case of a 45-year-old man who presented with complaints of fullness in his abdomen and splenomegaly that referred to the surgery clinic. He underwent diagnostic splenectomy. 3 month after splenectomy endocarditis was diagnosed. We recommend echocardiography in the work up of isolated splenomegaly.

No MeSH data available.


Related in: MedlinePlus