Splenic Rupture after Infective Endocarditis by Enterococcus faecalis: Case Report
Journal Title: Journal of Advances in Medicine and Medical Research - Year 2016, Vol 13, Issue 2
Abstract
Aims: In patients with infective endocarditis, with risk of embolization, early identification of parenchymal changes may suggest the risk of splenic rupture. Presentation of Case: A 68-year-old male presented with a history of 2 months of fever and also left upper quadrant pain initiated 2 days before admission. Transesophageal echocardiogram demonstrated the presence of two mobile vegetations on the ventricular side of the aortic valve; the largest diameter being 2.1 cm. Enterococcus faecalis was isolated in blood culture after a diagnosis of subacute aortic valve infective endocarditis. He complained of abdominal pain. An abdominal computed tomography scan revealed infarction of the upper region of the spleen (septic embolism). Therapy with penicillin and gentamicin was initiated, but the patient developed symptoms of heart failure that led to a surgical treatment, and aortic bioprosthesis was implanted on day 14. On day 5 postoperatively, the patient developed sudden hemorrhagic shock signs due to splenic rupture and underwent emergency splenectomy. A pathological examination revealed areas of splenic laceration of the capsule, splenic infarction areas, and the absence of abscesses. Splenic rupture is a complication much rarely occurring due to infectious endocarditis caused by E. faecalis. Conclusion: This case highlights the importance of conducting serial imaging, particularly in symptomatic patients, for the early detection of parenchymal changes that may suggest the risk of rupture.
Authors and Affiliations
Thiago Andrade Macedo, Antonio Claudio do Amaral Baruzzi, Pedro Gabriel de Melo Barros e Silva, Fabio Quartieri Alves, Renata Lopes Hames, Marcio Campos Sampaio, Jose Carlos Teixeira Garcia, Valter Furlan
Keywords
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- EP ID EP340201
- DOI 10.9734/BJMMR/2016/23389
- Views 64
- Downloads 0
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