ABSTRACT
The authors present the case of a 12-year old girl with infective endocarditis. Following an initial three-day period of malaise, she was admitted to the hospital with meningeal signs. The clinical symptoms and the results of the laboratory examinations, lumbar puncture and hemoculture supported the diagnosis of Staphylococcus sepsis and meningitis. The initiation of antimicrobial therapy resulted in temporary improvement while a systolic cardiac murmur appeared. Transthoracal echocardiogram raised the diagnosis of mitral valve endocarditis. Due to the subsequent deterioration in her condition, the patient was referred to the Pediatric Heart Center of the Gottsegen György National Institute of Cardiology where transoesophageal echocardiogram confirmed the diagnosis. The vegetations were removed by extracorporeal cardiac surgery including mitral valve plasty. Retrospectively, septic embolisation caused multiplex brain infarcts were identified by cranial MRI scan as the underlying cause of the initial clinical symptoms and liquor results. Following her recovery, patient remained well with some mild residual mitral regurgitation and without any residual neurological symptoms.
Subject(s)
Bacteremia/diagnosis , Bacteremia/therapy , Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/therapy , Mitral Valve/microbiology , Staphylococcal Infections/diagnosis , Staphylococcal Infections/therapy , Anti-Bacterial Agents/therapeutic use , Bacteremia/drug therapy , Bacteremia/microbiology , Cardiac Surgical Procedures/methods , Cerebral Infarction/diagnosis , Cerebral Infarction/microbiology , Child , Echocardiography , Echocardiography, Transesophageal , Endocarditis, Bacterial/diagnostic imaging , Endocarditis, Bacterial/drug therapy , Endocarditis, Bacterial/microbiology , Female , Heart Murmurs/microbiology , Humans , Magnetic Resonance Imaging , Mitral Valve/surgery , Staphylococcal Infections/diagnostic imaging , Staphylococcal Infections/drug therapy , Treatment OutcomeABSTRACT
A 16-years old boy with poor family circumstances was admitted to hospital due to severe cardiac failure (stagnation in the pulmonary and systemic circulations, ejection fraction: 29%, pericardial fluid, atrial flatter) needing intensive care. Diagnostic tests revealed extreme hyper-function of the thyroid as the underlying cause. After stabilising the cardiac and hormonal states of the patient with medication, subtotal resection of the thyroid was carried out since the poor family circumstances did not make the provision of long-term thyreostatic pharmacotherapy feasible. Cardioversion solved the arrhythmia. The patient was discharged from hospital with stable circulation and normal thyroid functions after 2 months. The authors report the very uncommon complications of an endocrine syndrome with autoimmune origin rarely observed in childhood. They highlight the importance of early diagnosis and the immediate start of adequate therapy for good long-term outcome.
