ABSTRACT
Infective Endocarditis (IE) is a very rare complication following spinal epidural injection and requires high index of suspicion for early diagnosis and effective management. Staphylococcus Lugdunesis is a coagulase negative staphylococcus (CoNS) that, unlike other CoNS, may result in aggressive form of native valve infective endocarditis (IE) mimicking IE caused by S aureus. Surgical intervention is usually needed to control infection in most cases of S. Lugdunesis IE. Herein, we report a case of young lady with congenital Gerbode defect who developed tricuspid native valve IE with S. Lugdunesis secondary to spondylodiscitis post lumbar epidural injection that was performed for disk prolapse. She required urgent surgical intervention and had an excellent outcome.
Subject(s)
Heart Neoplasms/diagnostic imaging , Heart Neoplasms/surgery , Pulmonary Embolism/diagnostic imaging , Pulmonary Veins/pathology , Sarcoma/pathology , Adult , Biopsy, Needle , Cardiac Surgical Procedures/adverse effects , Cardiac Surgical Procedures/methods , Computed Tomography Angiography/methods , Dyspnea/diagnosis , Dyspnea/etiology , Echocardiography/methods , Emergency Service, Hospital , Fatal Outcome , Heart Atria/diagnostic imaging , Heart Atria/pathology , Humans , Immunohistochemistry , Male , Multiple Organ Failure , Postoperative Complications/diagnosis , Pulmonary Embolism/diagnosis , Pulmonary Veins/diagnostic imaging , Sarcoma/diagnostic imaging , Sarcoma/surgeryABSTRACT
BACKGROUND: Post-operative rhabdomyolysis is a well-known complication, especially after bariatric and orthopaedic surgeries. There are few published reports of rhabdomyolysis following cardiac surgery. Acute kidney injury had been distinguished as a serious complication of cardiac surgery. We report a case of 55-years-old male patient who developed rhabdomyolysis precipitated acute kidney injury after coronary artery bypass graft. CASE PRESENTATION: The patient underwent urgent coronary artery bypass graft surgery, with a long duration of surgery due to technical difficulty during grafting. He developed rhabdomyolysis induced acute kidney injury necessitating hemodialysis. The patient in turn developed heart failure, which along with acute kidney injury lead to prolonged ventilation. There was supervening sepsis with prolonged intensive care unity stay and eventually prolonged hospitalization. The peak creatine kinase level was 39,000 IU/mL and peak myoglobin was 40,000 ng/ml. Reviewing the patient, surgery was prolonged due to technical difficulties encountered during grafting, leading to rhabdomyolysis induced acute kidney injury. The pre-operative use of statins by the patient could also have contributed to the development of rhabdomyolysis. He developed post-operative right heart failure and sepsis. The patient's renal function gradually improved over 4 week's duration. Favorable outcome could be achieved but after prolonged course of renal replacement therapy in the form of hemodialysis. CONCLUSION: Prolonged duration of surgery is a well-recognized risk factor in the development of rhabdomyolysis. Early recognition of rhabdomyolysis induced acute kidney injury is important in reducing the post-operative morbidity and mortality in patients. A protocol based approach could be applied for early recognition and management.
Subject(s)
Acute Kidney Injury/etiology , Coronary Artery Bypass/adverse effects , Postoperative Complications/etiology , Rhabdomyolysis/etiology , Acute Kidney Injury/therapy , Humans , Male , Middle Aged , Renal Dialysis , Risk Factors , Time FactorsABSTRACT
Detection of subclinical myocardial involvement is of utmost importance in risk stratification and prognosis; the role of ejection fraction in the detection of subclinical disease may be unhelpful. Our aim was to evaluate the methodology and importance of early detection of myocardial involvement in the presence of normal ejection fraction. Most of the pertinent English and non-English articles published from 1980 to 2006 in Medline, Scopus, and EBSCO Host research databases have been reviewed. Serial assessment of systolic function with different techniques should be avoided, since imaging modalities and ejection fraction measurements are not interchangeable. Additional non-invasive tools still are needed for the identification of subclinical left ventricular dysfunction in certain diseases. The recognition of subclinical involvement will prompt initiation of specific therapy to prevent the development of overt left ventricular dysfunction. This also is needed for determining the best timing for intervention in asymptomatic patients with metabolic and valvular disorders.
