Infective endocarditis at autopsy: 1965–1969

Robinson, Morton J.; Greenberg, Jack J.; Korn, Morton; Rywlin, Arkadi M.

doi:10.1016/0002-9343(72)90040-x

Cited by 39 publications

(1 citation statement)

References 12 publications

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“…Valvular tissue obtained at surgery or at autopsy from patients with endocarditis and negative blood cultures has yielded viridans streptococci, Staphylococcus aureus, coagulase-negative staphylococci, and other organisms associated with culture-positive disease. 3,4 Indeed, at one time culture-negative endocarditis was thought to be a phase in the course of the illness during which the body's defense mechanisms were unable to stabilize or heal the infection. 5 Another cause of initially negative cultures is a slowgrowing or nutritionally fastidious pathogen.…”

Section: Differential Diagnosismentioning

confidence: 99%

Case 2-1997

Jacoby¹,

Hay²

1997

N Engl J Med

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A 38-year-old schizophrenic man was admitted to the hospital because of digital clubbing and a cardiac murmur.The patient had been well until about one year earlier, when he began to have swelling of the fingers and toes. Eleven months before admission, an evaluation elsewhere showed a grade 2 systolic murmur at the lower left sternal border. One month before admission, he underwent a dental extraction and took ampicillin prophylactically for two days. On the day of admission, examination of the patient in the medical clinic revealed two loud murmurs. A cardiac ultrasonographic examination showed severe mitral and aortic regurgitation. A bright, mobile, linear, echodense lesion was attached to the anterior mitral leaflet and prolapsed into the left atrium during systole. The finding suggested a ruptured chorda tendinea and papillary apparatus, but the possibility of a vegetation could not be excluded. Portions of the anterior mitral leaflet were partially flail. Echodense lesions were attached to the noncoronary cusp of the aortic valve, a finding consistent with vegetations or a torn leaflet. An anechoic area in the region of the left sinus of Valsalva was suggestive of an abscess or a small aneurysm. The left ventricle was dilated, with an estimated ejection fraction of 71 percent. The patient left the hospital, but outreach workers persuaded him to return, and he was admitted.The patient was homeless and unemployed, and he slept in a shelter. There was a long history of paranoid schizophrenia, which was managed at a longterm care hospital with haloperidol and nortriptyline, and of dental problems with recently painful teeth. He smoked two packs of cigarettes daily and rarely drank alcohol. He had traveled throughout the United States in recent years, but had not left the country.His father and mother had both died of myocardial infarcts, and his mother had had carcinoma of the colon. A test for human immunodeficiency virus (HIV) antibodies one year before admission was negative. There was no history of rheumatic fever, valvular heart disease, trauma, genitourinary manipulation, dyspnea, orthopnea, chest pain, fever, sweats, intravenous drug abuse, exposure to animals, arthralgia, rash, or weight loss, and he had not been sexually active with partners of either sex for many years.The temperature was 37.8°C, the pulse was 127, and the respirations were 20. The blood pressure was 155/60 mm Hg.On examination, the patient did not appear ill. No rash, cutaneous or ophthalmic sign of bacterial endocarditis, or lymphadenopathy was found. His dental hygiene was poor. The jugular venous pressure was less than 5 cm, and the thyroid gland was not enlarged. The lungs were clear. A cardiac examination showed a right ventricular heave. A grade 3 holosystolic murmur was heard at the apex, with prominent radiation to the axilla and left sternal border. A grade 2 aortic diastolic murmur and S4 were audible. The abdomen was normal. Marked clubbing of the fingers and toes was observed. There was peripheral evidence of aortic regu...

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Section: Differential Diagnosismentioning

confidence: 99%