Infective endocarditis due to high level aminoglycoside resistant Enterococcus faecalis and methicillin resistant coagulase-negative staphylococci presenting with rheumatic manifestations

Infective endocarditis has variable clinical presentations and may present with rheumatologic manifestations. Infective endocarditis due to high level aminoglycoside resistant enterococci represents a severe therapeutic challenge as none of the currently recommended treatment regimens are bactericidal against these isolates. In this report, a case of infective endocarditis with double aetiology, high level aminoglycoside resistant Enterococcus faecalis together with methicillin-resistant coagulase-negative staphylococci (MR-CNS), presenting with leukocytoclastic vasculitis and rapidly progressive glomerulonephritis, has been presented. A 48-years-old woman was admitted to our hospital with malaise and non-pruritic purpural rush on her lower extremities. On admission she had no fever or leukocytosis. Skin biopsy showed leukocytoclastic vasculitis and steroid therapy was started. On 12(th) day of admission rapidly progressive glomerulonephritis was diagnosed and she received plasmapheresis and haemodialysis support. Transthoracic echocardiography (TTE) demonstrated 1 x 1.5 cm vegetation on the mitral valve. An initial diagnosis of infective endocarditis was made and empirical treatment with vancomycin and gentamicin was started. All blood cultures yielded high level aminoglycoside resistant E. faecalis and additionally two of them yielded MR-CNS. Vancomycin was administered in combination with high dose ampicillin and repeated blood cultures taken after administration of ampicillin, revealed no growth. The patient remained afebrile, renal functions improved and a repeat TTE done on 20(th) day of ampicillin therapy showed waning of the vegetation. On 42(nd) day of treatment repeat TTE showed new vegetation on the mitral valve and severe valve insufficiency, so the patient was scheduled for mitral valve replacement. She was treated for 12 weeks with vancomycin and ampicillin and recovered successfully. In conclusion; infective endocarditis should be considered in the differential diagnosis of leukocytoclastic vasculitis and rapidly progressive glomerulonephritis. Physicians should document their treatment outcomes and experience with high level aminoglycoside resistant enterococcal infective endocarditis, which is a therapeutic challenge, so that the best therapeutic options can be identified.

Dergi Adı MIKROBIYOLOJI BULTENI
Dergi Cilt Bilgisi 42
Dergi Sayısı 3
Sayfalar 509 - 514
Yayın Yılı 2008
Eser Adı
[dc.title]
Infective endocarditis due to high level aminoglycoside resistant Enterococcus faecalis and methicillin resistant coagulase-negative staphylococci presenting with rheumatic manifestations
Yazar
[dc.contributor.author]
Piskin, Nihal
Yazar
[dc.contributor.author]
Akduman, Deniz
Yazar
[dc.contributor.author]
Aydemir, Hande
Yazar
[dc.contributor.author]
Celebi, Gueven
Yazar
[dc.contributor.author]
Oeztoprak, Nefise
Yazar
[dc.contributor.author]
Aktas, Elif
Yayın Yılı
[dc.date.issued]
2008
Yayıncı
[dc.publisher]
ANKARA MICROBIOLOGY SOC
Yayın Türü
[dc.type]
article
Özet
[dc.description.abstract]
Infective endocarditis has variable clinical presentations and may present with rheumatologic manifestations. Infective endocarditis due to high level aminoglycoside resistant enterococci represents a severe therapeutic challenge as none of the currently recommended treatment regimens are bactericidal against these isolates. In this report, a case of infective endocarditis with double aetiology, high level aminoglycoside resistant Enterococcus faecalis together with methicillin-resistant coagulase-negative staphylococci (MR-CNS), presenting with leukocytoclastic vasculitis and rapidly progressive glomerulonephritis, has been presented. A 48-years-old woman was admitted to our hospital with malaise and non-pruritic purpural rush on her lower extremities. On admission she had no fever or leukocytosis. Skin biopsy showed leukocytoclastic vasculitis and steroid therapy was started. On 12(th) day of admission rapidly progressive glomerulonephritis was diagnosed and she received plasmapheresis and haemodialysis support. Transthoracic echocardiography (TTE) demonstrated 1 x 1.5 cm vegetation on the mitral valve. An initial diagnosis of infective endocarditis was made and empirical treatment with vancomycin and gentamicin was started. All blood cultures yielded high level aminoglycoside resistant E. faecalis and additionally two of them yielded MR-CNS. Vancomycin was administered in combination with high dose ampicillin and repeated blood cultures taken after administration of ampicillin, revealed no growth. The patient remained afebrile, renal functions improved and a repeat TTE done on 20(th) day of ampicillin therapy showed waning of the vegetation. On 42(nd) day of treatment repeat TTE showed new vegetation on the mitral valve and severe valve insufficiency, so the patient was scheduled for mitral valve replacement. She was treated for 12 weeks with vancomycin and ampicillin and recovered successfully. In conclusion; infective endocarditis should be considered in the differential diagnosis of leukocytoclastic vasculitis and rapidly progressive glomerulonephritis. Physicians should document their treatment outcomes and experience with high level aminoglycoside resistant enterococcal infective endocarditis, which is a therapeutic challenge, so that the best therapeutic options can be identified.
Açıklama
[dc.description]
WOS: 000258416900018
Açıklama
[dc.description]
PubMed: 18822897
Kayıt Giriş Tarihi
[dc.date.accessioned]
2019-12-23
Açık Erişim Tarihi
[dc.date.available]
2019-12-23
Yayın Dili
[dc.language.iso]
tur
Konu Başlıkları
[dc.subject]
infective endocarditis
Konu Başlıkları
[dc.subject]
high level aminoglycoside resistance
Konu Başlıkları
[dc.subject]
enterococci
Konu Başlıkları
[dc.subject]
leukocytoclastic vasculitis
Konu Başlıkları
[dc.subject]
glomerulonephritis
Haklar
[dc.rights]
info:eu-repo/semantics/closedAccess
ISSN
[dc.identifier.issn]
0374-9096
İlk Sayfa Sayısı
[dc.identifier.startpage]
509
Son Sayfa Sayısı
[dc.identifier.endpage]
514
Dergi Adı
[dc.relation.journal]
MIKROBIYOLOJI BULTENI
Dergi Sayısı
[dc.identifier.issue]
3
Dergi Cilt Bilgisi
[dc.identifier.volume]
42
Tek Biçim Adres
[dc.identifier.uri]
https://hdl.handle.net/20.500.12628/2775
Görüntülenme Sayısı ( Şehir )
Görüntülenme Sayısı ( Ülke )
Görüntülenme Sayısı ( Zaman Dağılımı )
Görüntülenme
42
09.12.2022 tarihinden bu yana
İndirme
1
09.12.2022 tarihinden bu yana
Son Erişim Tarihi
09 Şubat 2024 09:54
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Tıklayınız
endocarditis treatment resistant aminoglycoside ampicillin infective glomerulonephritis progressive rapidly leukocytoclastic vasculitis showed mitral vegetation therapeutic repeat diagnosis vancomycin patient cultures yielded started admission therapy faecalis Infective challenge severe should MR-CNS combination administered outcomes experience enterococcal
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