模拟棒状杆菌引起感染性心内膜炎伴栓塞事件的罕见病例

Shu Ann Hon, Lian Thai Lee, Ri Ann Lee, Qin Jian Low
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摘要

棒状杆菌通常被视为污染物。然而,最近在全球范围内报告了几起涉及棒状杆菌种类的疫情。我们报告一例罕见的模拟棒状杆菌引起感染性心内膜炎,导致衰弱的栓塞事件。一位39岁的女士表现出持续三周的发烧。她患有感染性休克,右偏瘫,二尖瓣区有全收缩期杂音,肝脾肿大。未见感染性心内膜炎周围污斑。紧急电脑断层扫描(CT)显示左侧放射冠梗死,延伸至左侧顶叶、左侧基底神经节和左侧颞叶。她病情恶化,需要机械通气和重症监护。超声心动图显示,她的前、后二尖瓣小叶均有植被,导致严重的二尖瓣反流。腹部对比计算机断层扫描显示脾梗死。她的三个血液培养样本模拟棒状杆菌阳性。她病情迅速恶化,多器官衰竭,最终死亡。棒状杆菌物种应该被认真对待,不应该被忽视,因为它可能导致本病例报告中描述的潜在致命并发症。
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An Unusual Case of Corynebacterium simulans causes Infective Endocarditis with Embolic Events
Corynebacterium species are often treated as contaminants. However, there were several recent outbreaks involving Corynebacterium species reported across the globe. We report a rare case of Corynebacterium simulans causes infective endocarditis which led to debilitating embolic events. A 39-year-old lady presented with a prolonged fever for three weeks. She was in septic shock and had dense right hemiplegia, a pansystolic murmur at the mitral area and hepatosplenomegaly. There were no peripheral stigmata of infective endocarditis. An urgent computed tomography (CT) of the brain showed an infarct at the left corona radiata extending to the left parietal, left basal ganglia and left temporal lobe. She deteriorated and required mechanical ventilation and intensive care. Echocardiogram showed vegetation at both her anterior and posterior mitral valve leaflets leading to severe mitral regurgitation. Splenic infarction was seen in her contrasted computed tomography (CECT) of her abdomen. Her three samples of blood culture were positive for Corynebacterium simulans. She deteriorated rapidly and went into multi-organ failure and succumbed. Corynebacterium species should be taken seriously and should not be neglected as a contaminant as it can cause potentially fatal complications as described in this case report.
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