A Case of Infective Bacterial Endocarditis Complicated by Acute Hemorrhagic Pericarditis and Hemoperitoneum by Rupture of Mycotic Aneurysm at Superior Mesenteric Artery

Infective endocarditis is a disease that is characterized by the vegetations. Although cardiac complications remain the leading cause of death, endocarditis is complex, systemic illness with involvement of virtually all the organs. The spectrum and incidence of cardiovasular, neurologic, renal complications also are presented by direct embolism and immune- mediated phenomena. Systemic embolism is the common and serious complications associated with infective endocarditis. Mycotic aneurysm by septic embolization is known complication of bacterial endocarditis, but mycotic aneurysm of superior mesenteric artery is very rare complication and approximately 10 cases has been reported in the literature. Acute hemorrhagic pericarditis is unusual clinical manifestation of bacterial endocarditis and subject to catastrophic hemodynamic compromise secondary to cardiac tamponade. We report a case of bacterial endocarditis in 23 years old male who developed acute hemorrhagic pericarditis and hemoperitoneum due to rupture of mycotic aneurysm in superior mesenteric artery with brief review of lieratures.

A Case of Wegener's Granulomatosis with Acute Renal Failure and Pneumothorax Developed during Treatment with Immunosuppressive Agent / 대한신장학회잡지

Wegener's granulomatosis is characterized by necrotizing granulomatosis lesion of the respiratory tract, glomerulonephritis and frequently vasculitis involving other organs. The basic pathophysiologic mechanism of Wegener's granulomatosis is not defined yet. However, it may be suspected an autoimmune disease. We experienced a case of Wegener's granulomatosis which are associated with acute renal failure and pneumothorax. The patient suffered from hemoptysis, fever and cough. Despite antibiotic therapy, symtoms did not improved and multiple varying sized nodules were aggravated on chest roentogenogram and serum creatinine elevated 3.4mg/dl. After diagnosis using video associated thoracoscopic surgery, the patient was treated with cyclophsphamide, glucocorticoid and sulfamethoxasole-trimethoprime. With the combination therapy, the patient felt completely well and chest roentogenogram showed lungs were improved and serum creatinine was normal. The patient was readmitted because of right pleuritic pain and dyspnea 15 day after discharge. The patient was developed a right pneumothorax. The lung was easily expanded by intercostal tube drainage with a one way valve. The patient has been treated as an out- patient with immunosuppressive agents continously.