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A case report: Infective endocarditis with a vegetation in the tricuspid valve, complicated by lung abscess

, : A case report: Infective endocarditis with a vegetation in the tricuspid valve, complicated by lung abscess. Nihon University Journal of Medicine 43(2): 115-125, April

Infective endocarditis involving the tricuspid valve alone is rare in Japan. It is predominantly a disease of intravenous drug abusers, congenital heart disease and foreign body insertion (e.g. pacemaker implantation). This disease has been reported to occur extreme rarely in healthy adults. A 35-year-old man had been admitted to another hospital 5 weeks previously with fever, cough and bloody sputum. An antipyretic agent was prescribed at a local clinic, but did not relieve these symptoms. Thoracic computed tomography (CT) disclosed multiple infiltrative shadows, suggesting lung abscess. Simultaneously, a blood culture grew Staphylococcus aureus, and the patient was treated with antibiotics. His condition did not improve, and he was therefore referred to our hospital. Echocardiography revealed a vegetation in the tricuspid valve, suggesting infective endocarditis. He was diagnosed as having lung abscess caused by this disease. Combination therapy with panipenem (PAPM) and fosfomycin (FOM) was started. The patient became negative for CRP at 43 days after admission, at which time the vegetation was markedly reduced. The cause of the infection was not clarified. Multiple lung abscess lesions concurrently developed, and the persistent vegetation, tricuspid perforation and tricuspid regurgitation were noted even after antibiotic therapy resulting in CRP-negative findings. Tricuspid plasty was therefore performed.


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