Endocarditis: A Diagnostic Challenge

oleh: Wilhelmina J. A. R. M. Valckx MD, Suzanne P. M. Lutgens MD, PhD, Hortence E. Haerkens-Arends MD, Peter C. Barneveld MD, Jaap J. Beutler MD, PhD, Ellen K. Hoogeveen MD, PhD

Format: Article
Diterbitkan: SAGE Publishing 2017-04-01

Deskripsi

A 74-year-old hemodialysis patient with a history of an atrial septum defect closure, coronary bypass surgery, and a St. Jude aortic prosthetic valve was diagnosed with pneumonia and volume overload. Blood cultures were positive for Listeria monocytogenes , and amoxicillin was given for 2 weeks. Immediately after discontinuation of amoxicillin, fever relapsed. Transthoracic and transesophageal echocardiography showed no sign of endocarditis. Given the fever relapse and 3 positive minor Duke criteria, an 18 F-FDG PET-CT scan ( 18 F-fluorodeoxyglucose-positron emission tomography-computed tomography) scan was performed. This scan showed activity at the aortic root, proximal ascending aorta, and inferior wall of the heart, making Listeria monocytogenes endocarditis a likely explanation. Amoxicillin was given for 6 weeks with good clinical result. Diagnosing a life-threatening Listeria monocytogenes endocarditis can be challenging and an 18 F-FDG PET-CT scan can be helpful.