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Cardiac device-related endocarditis in the patient with end-stage renal failure in the course of Fabry disease.

Tomaszuk-Kazberuk A, Lopatowska P, Mlodawska E, Sobkowicz B, Kalinowski M, Glowinski J, Musial W, Malyszko J - Int Urol Nephrol (2013)

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Medical University, Białystok, Poland.

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The patient was treated with parenteral vanocomycin and gentamycin according to the guidelines... The microbiological results revealed Staphylococcus aureus... On the 11th day of hospitalization, a percutaneous extraction of the infected pacemaker together with infected lead was performer and antibiotics were continued... After 4 weeks of therapy and obtaining negative results of blood culture, the patient had a VVI pacemaker implanted without complications... Hemodialysis was started with catheter, then the an a-v anastomosis was performed using Konner’s modification Gracz fistula... After a month, a fully matured fistula was found, but over the course of the next few weeks, it became fibrotic... We have presented an exclusive case of favorable outcome of CDRE in the patient with end-stage renal failure in the course of Fabry disease... Furthermore, many patients develop kidney failure and require renal replacement therapy before being diagnosed with Fabry disease (1)... Recent retrospective studies have shown that 1–8 % of Fabry patients require pacemakers implantation... Unfortunately, the use of cardiovascular implantable electronic devices is associated with a risk of infection even in the general population... The reported incidence of infection of cardiac devices ranges from 0.5 % to 5.1 % and is associated with substantial morbidity and mortality... Patients with Fabry disease, as most of the develop end-stage renal failure, are at increased risk of cardiac device-related endocarditis... In our case, CDRE and subsequent treatment with nephrotoxic drugs, including vancomycin, was the reason for significant worsening of renal function requiring the start of renal replacement therapy.

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A mass in the right atrium (indicated by arrow), above the tricuspid valve, attached to the device lead on the transesophageal echocardiography (TEE)
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Fig1: A mass in the right atrium (indicated by arrow), above the tricuspid valve, attached to the device lead on the transesophageal echocardiography (TEE)

Mentions: A chest X-ray did not reveal any specific abnormalities. Ultrasonography of the area of the pacemaker pocket detected an abscess, which was then incised, drained and cultures. At the same time three blood specimens were taken for culture. A transthoracic echocardiogram (TTE) revealed left ventricular hypertrophy, ejection fraction 55 %, significant mitral regurgitation and a mobile mass of approximately 16 × 16 mm on the septal tricuspid leaflet. No presence of an abscess was recorded. A transesophageal echocardiography (TEE) revealed a mass of maximum size 12 × 22 mm in the right atrium, above the tricuspid valve, attached to the device lead (Fig. 1).Fig. 1


Cardiac device-related endocarditis in the patient with end-stage renal failure in the course of Fabry disease.

Tomaszuk-Kazberuk A, Lopatowska P, Mlodawska E, Sobkowicz B, Kalinowski M, Glowinski J, Musial W, Malyszko J - Int Urol Nephrol (2013)

A mass in the right atrium (indicated by arrow), above the tricuspid valve, attached to the device lead on the transesophageal echocardiography (TEE)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3824399&req=5

Fig1: A mass in the right atrium (indicated by arrow), above the tricuspid valve, attached to the device lead on the transesophageal echocardiography (TEE)
Mentions: A chest X-ray did not reveal any specific abnormalities. Ultrasonography of the area of the pacemaker pocket detected an abscess, which was then incised, drained and cultures. At the same time three blood specimens were taken for culture. A transthoracic echocardiogram (TTE) revealed left ventricular hypertrophy, ejection fraction 55 %, significant mitral regurgitation and a mobile mass of approximately 16 × 16 mm on the septal tricuspid leaflet. No presence of an abscess was recorded. A transesophageal echocardiography (TEE) revealed a mass of maximum size 12 × 22 mm in the right atrium, above the tricuspid valve, attached to the device lead (Fig. 1).Fig. 1

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Medical University, Białystok, Poland.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

The patient was treated with parenteral vanocomycin and gentamycin according to the guidelines... The microbiological results revealed Staphylococcus aureus... On the 11th day of hospitalization, a percutaneous extraction of the infected pacemaker together with infected lead was performer and antibiotics were continued... After 4 weeks of therapy and obtaining negative results of blood culture, the patient had a VVI pacemaker implanted without complications... Hemodialysis was started with catheter, then the an a-v anastomosis was performed using Konner’s modification Gracz fistula... After a month, a fully matured fistula was found, but over the course of the next few weeks, it became fibrotic... We have presented an exclusive case of favorable outcome of CDRE in the patient with end-stage renal failure in the course of Fabry disease... Furthermore, many patients develop kidney failure and require renal replacement therapy before being diagnosed with Fabry disease (1)... Recent retrospective studies have shown that 1–8 % of Fabry patients require pacemakers implantation... Unfortunately, the use of cardiovascular implantable electronic devices is associated with a risk of infection even in the general population... The reported incidence of infection of cardiac devices ranges from 0.5 % to 5.1 % and is associated with substantial morbidity and mortality... Patients with Fabry disease, as most of the develop end-stage renal failure, are at increased risk of cardiac device-related endocarditis... In our case, CDRE and subsequent treatment with nephrotoxic drugs, including vancomycin, was the reason for significant worsening of renal function requiring the start of renal replacement therapy.

Show MeSH