Implantable cardioverter defibrillator endocarditis caused by Klebsiella pneumoniae complicated by liver abscess and septic pulmonary embolism
A 63-year old diabetic male patient carrying an implantable cardioverter defibrillator (ICD) was hospitalized with a 7- day history of fever, notwithstanding an antibiotic therapy. The white-blood cell count was 11,000/mm<sup>3</sup>, the platelet count was 135,000/mm<sup>3</sup...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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PAGEPress Publications
2013-11-01
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| Series: | Italian Journal of Medicine |
| Subjects: | |
| Online Access: | http://www.italjmed.org/index.php/ijm/article/view/407 |
| _version_ | 1797429588268154880 |
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| author | Ilaria Izzo Stefano Ettori Paolo Colombini Marco Cannata Adriano Pagani Daniele Bella |
| author_facet | Ilaria Izzo Stefano Ettori Paolo Colombini Marco Cannata Adriano Pagani Daniele Bella |
| author_sort | Ilaria Izzo |
| collection | DOAJ |
| description | A 63-year old diabetic male patient carrying an implantable cardioverter defibrillator (ICD) was hospitalized with a 7- day history of fever, notwithstanding an antibiotic therapy. The white-blood cell count was 11,000/mm<sup>3</sup>, the platelet count was 135,000/mm<sup>3</sup> and C-reactive protein (CRP) 13 mg/dL. Chest X-rays showed right infiltrates. Ceftriaxone was started. Defervescence was rapid, but CRP was still 12 mg/dL after 6 days. A trans-thoracic ecochacardiogram (TTE) incidentally showed a liver hypoechoic lesion. A computed tomography scan revealed bilateral cavitated lung nodules and a large liver abscess. <em>Klebsiella pneumoniae</em> was isolated in blood cultures and TTE showed ICD endocarditis and a patent <em>foramen ovalis</em>. Levofloxacin and imipenem/cilastatin were started. The liver abscess was drained. After 30 days, the ICD was removed and re-implanted. At discharge, blood tests were within the normal range and the patient was asymptomatic. Follow up showed improvement of lung and hepatic lesions. To our knowledge, this is the second reported case of <em>K. pneumoniae</em> infective endocarditis with multiple septic emboli. Endocarditis should be suspected in presence of fever after the device implantation, in particular if risk factors are present. |
| first_indexed | 2024-03-09T09:15:18Z |
| format | Article |
| id | doaj.art-e8280fe61108454ba09d272adede80cb |
| institution | Directory Open Access Journal |
| issn | 1877-9344 1877-9352 |
| language | English |
| last_indexed | 2024-03-09T09:15:18Z |
| publishDate | 2013-11-01 |
| publisher | PAGEPress Publications |
| record_format | Article |
| series | Italian Journal of Medicine |
| spelling | doaj.art-e8280fe61108454ba09d272adede80cb2023-12-02T07:13:29ZengPAGEPress PublicationsItalian Journal of Medicine1877-93441877-93522013-11-018212412610.4081/itjm.2013.407359Implantable cardioverter defibrillator endocarditis caused by Klebsiella pneumoniae complicated by liver abscess and septic pulmonary embolismIlaria Izzo0Stefano Ettori1Paolo Colombini2Marco Cannata3Adriano Pagani4Daniele Bella5UO Medicina Interna, AO Mellino Mellini, Chiari (BS)UO Medicina Interna, AO Mellino Mellini, Chiari (BS)UO Medicina Interna, AO Mellino Mellini, Chiari (BS)Università degli Studi di Brescia, BresciaUO Medicina Interna, AO Mellino Mellini, Chiari (BS)UO Medicina Interna, AO Mellino Mellini, Chiari (BS)A 63-year old diabetic male patient carrying an implantable cardioverter defibrillator (ICD) was hospitalized with a 7- day history of fever, notwithstanding an antibiotic therapy. The white-blood cell count was 11,000/mm<sup>3</sup>, the platelet count was 135,000/mm<sup>3</sup> and C-reactive protein (CRP) 13 mg/dL. Chest X-rays showed right infiltrates. Ceftriaxone was started. Defervescence was rapid, but CRP was still 12 mg/dL after 6 days. A trans-thoracic ecochacardiogram (TTE) incidentally showed a liver hypoechoic lesion. A computed tomography scan revealed bilateral cavitated lung nodules and a large liver abscess. <em>Klebsiella pneumoniae</em> was isolated in blood cultures and TTE showed ICD endocarditis and a patent <em>foramen ovalis</em>. Levofloxacin and imipenem/cilastatin were started. The liver abscess was drained. After 30 days, the ICD was removed and re-implanted. At discharge, blood tests were within the normal range and the patient was asymptomatic. Follow up showed improvement of lung and hepatic lesions. To our knowledge, this is the second reported case of <em>K. pneumoniae</em> infective endocarditis with multiple septic emboli. Endocarditis should be suspected in presence of fever after the device implantation, in particular if risk factors are present.http://www.italjmed.org/index.php/ijm/article/view/407implatable cardioverter defibrillator, endocarditis, Klebsiella pneumoniae, liver abscess. |
| spellingShingle | Ilaria Izzo Stefano Ettori Paolo Colombini Marco Cannata Adriano Pagani Daniele Bella Implantable cardioverter defibrillator endocarditis caused by Klebsiella pneumoniae complicated by liver abscess and septic pulmonary embolism Italian Journal of Medicine implatable cardioverter defibrillator, endocarditis, Klebsiella pneumoniae, liver abscess. |
| title | Implantable cardioverter defibrillator endocarditis caused by Klebsiella pneumoniae complicated by liver abscess and septic pulmonary embolism |
| title_full | Implantable cardioverter defibrillator endocarditis caused by Klebsiella pneumoniae complicated by liver abscess and septic pulmonary embolism |
| title_fullStr | Implantable cardioverter defibrillator endocarditis caused by Klebsiella pneumoniae complicated by liver abscess and septic pulmonary embolism |
| title_full_unstemmed | Implantable cardioverter defibrillator endocarditis caused by Klebsiella pneumoniae complicated by liver abscess and septic pulmonary embolism |
| title_short | Implantable cardioverter defibrillator endocarditis caused by Klebsiella pneumoniae complicated by liver abscess and septic pulmonary embolism |
| title_sort | implantable cardioverter defibrillator endocarditis caused by klebsiella pneumoniae complicated by liver abscess and septic pulmonary embolism |
| topic | implatable cardioverter defibrillator, endocarditis, Klebsiella pneumoniae, liver abscess. |
| url | http://www.italjmed.org/index.php/ijm/article/view/407 |
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