Fulminant infectious endocarditis caused by Staphylococcus aureus with pseudoaneurysms in the superior mesenteric, hepatic, and popliteal arteries: a case report
Staphylococcus aureus infectious endocarditis has a high mortality, major causes of death being cardiac failure, systemic embolism, and sepsis. Pseudoaneurysms, a rare complication of this infection, are not invariably fatal with appropriate treatment. A previously healthy 32-year-old man was found...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-10-01
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| Series: | Radiology Case Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1930043322006239 |
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| author | Shoko Merrit Yamada, MD, PhD Takaki Hayashi, MD, PhD Aya Fuchioka, MD Tatsuya Aso, MD, PhD Mikiko Takahashi, MD, PhD |
| author_facet | Shoko Merrit Yamada, MD, PhD Takaki Hayashi, MD, PhD Aya Fuchioka, MD Tatsuya Aso, MD, PhD Mikiko Takahashi, MD, PhD |
| author_sort | Shoko Merrit Yamada, MD, PhD |
| collection | DOAJ |
| description | Staphylococcus aureus infectious endocarditis has a high mortality, major causes of death being cardiac failure, systemic embolism, and sepsis. Pseudoaneurysms, a rare complication of this infection, are not invariably fatal with appropriate treatment. A previously healthy 32-year-old man was found to have multiple cerebral infarctions, and infectious endocarditis with mitral valve vegetation was diagnosed by echocardiography. Because methicillin-resistant Staphylococcus aureus (MRSA) was identified from blood cultures, vancomycin was administered. Massive intracerebral hemorrhage in the left temporo-occipital lobe occurred in the patient on the 3rd day after admission, and the hematoma was completely removed surgically. Another hemorrhage was identified in the right occipital region on the 7th hospital day, which led the patient deep coma. Blood cultures on the 10th day were negative for MRSA; however, imaging studies revealed pseudoaneurysms in the superior mesenteric, hepatic, and left popliteal arteries 3 weeks after admission. No surgical indication was applied to these pseudoaneurysms because the patient remained comatose. On the 78th day after admission, the patient's blood pressure suddenly dropped and he died. Autopsy demonstrated massive bleeding in the abdominal cavity caused by rupture of the superior mesenteric artery pseudoaneurysm. Our patient's clinical course was fulminant, his endocarditis being complicated by cerebral infarctions, intracranial hemorrhages, and multiple pseudoaneurysms within 3 weeks of admission. In retrospect, he may have survived if emergency resection of the mitral valve vegetation had been performed on the first or second day of admission; however, the in-hospital mortality rate after such surgery is high. |
| first_indexed | 2024-04-11T21:16:32Z |
| format | Article |
| id | doaj.art-3b589e254ee0499183333a3c059da058 |
| institution | Directory Open Access Journal |
| issn | 1930-0433 |
| language | English |
| last_indexed | 2024-04-11T21:16:32Z |
| publishDate | 2022-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Radiology Case Reports |
| spelling | doaj.art-3b589e254ee0499183333a3c059da0582022-12-22T04:02:48ZengElsevierRadiology Case Reports1930-04332022-10-01171038413846Fulminant infectious endocarditis caused by Staphylococcus aureus with pseudoaneurysms in the superior mesenteric, hepatic, and popliteal arteries: a case reportShoko Merrit Yamada, MD, PhD0Takaki Hayashi, MD, PhD1Aya Fuchioka, MD2Tatsuya Aso, MD, PhD3Mikiko Takahashi, MD, PhD4Department of Neurosurgery, Teikyo University Mizonokuchi Hospital, 5-1-1 Futago, Takatsu-ku, Kawasaki, Kanagawa 213-8507, Japan; Corresponding author.Department of Radiology, Teikyo University Mizonokuchi Hospital, 5-1-1 Futago, Takatsu-ku, Kawasaki, Kanagawa 213-8507, JapanDepartment of Radiology, Teikyo University Mizonokuchi Hospital, 5-1-1 Futago, Takatsu-ku, Kawasaki, Kanagawa 213-8507, JapanDepartment of Diagnostic pathology, Teikyo University Mizonokuchi Hospital, 5-1-1 Futago, Takatsu-ku, Kawasaki, Kanagawa 213-8507, JapanDepartment of Diagnostic pathology, Teikyo University Mizonokuchi Hospital, 5-1-1 Futago, Takatsu-ku, Kawasaki, Kanagawa 213-8507, JapanStaphylococcus aureus infectious endocarditis has a high mortality, major causes of death being cardiac failure, systemic embolism, and sepsis. Pseudoaneurysms, a rare complication of this infection, are not invariably fatal with appropriate treatment. A previously healthy 32-year-old man was found to have multiple cerebral infarctions, and infectious endocarditis with mitral valve vegetation was diagnosed by echocardiography. Because methicillin-resistant Staphylococcus aureus (MRSA) was identified from blood cultures, vancomycin was administered. Massive intracerebral hemorrhage in the left temporo-occipital lobe occurred in the patient on the 3rd day after admission, and the hematoma was completely removed surgically. Another hemorrhage was identified in the right occipital region on the 7th hospital day, which led the patient deep coma. Blood cultures on the 10th day were negative for MRSA; however, imaging studies revealed pseudoaneurysms in the superior mesenteric, hepatic, and left popliteal arteries 3 weeks after admission. No surgical indication was applied to these pseudoaneurysms because the patient remained comatose. On the 78th day after admission, the patient's blood pressure suddenly dropped and he died. Autopsy demonstrated massive bleeding in the abdominal cavity caused by rupture of the superior mesenteric artery pseudoaneurysm. Our patient's clinical course was fulminant, his endocarditis being complicated by cerebral infarctions, intracranial hemorrhages, and multiple pseudoaneurysms within 3 weeks of admission. In retrospect, he may have survived if emergency resection of the mitral valve vegetation had been performed on the first or second day of admission; however, the in-hospital mortality rate after such surgery is high.http://www.sciencedirect.com/science/article/pii/S1930043322006239Infectious endocarditisStaphylococcusPseudoaneurysmAutopsy |
| spellingShingle | Shoko Merrit Yamada, MD, PhD Takaki Hayashi, MD, PhD Aya Fuchioka, MD Tatsuya Aso, MD, PhD Mikiko Takahashi, MD, PhD Fulminant infectious endocarditis caused by Staphylococcus aureus with pseudoaneurysms in the superior mesenteric, hepatic, and popliteal arteries: a case report Radiology Case Reports Infectious endocarditis Staphylococcus Pseudoaneurysm Autopsy |
| title | Fulminant infectious endocarditis caused by Staphylococcus aureus with pseudoaneurysms in the superior mesenteric, hepatic, and popliteal arteries: a case report |
| title_full | Fulminant infectious endocarditis caused by Staphylococcus aureus with pseudoaneurysms in the superior mesenteric, hepatic, and popliteal arteries: a case report |
| title_fullStr | Fulminant infectious endocarditis caused by Staphylococcus aureus with pseudoaneurysms in the superior mesenteric, hepatic, and popliteal arteries: a case report |
| title_full_unstemmed | Fulminant infectious endocarditis caused by Staphylococcus aureus with pseudoaneurysms in the superior mesenteric, hepatic, and popliteal arteries: a case report |
| title_short | Fulminant infectious endocarditis caused by Staphylococcus aureus with pseudoaneurysms in the superior mesenteric, hepatic, and popliteal arteries: a case report |
| title_sort | fulminant infectious endocarditis caused by staphylococcus aureus with pseudoaneurysms in the superior mesenteric hepatic and popliteal arteries a case report |
| topic | Infectious endocarditis Staphylococcus Pseudoaneurysm Autopsy |
| url | http://www.sciencedirect.com/science/article/pii/S1930043322006239 |
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