According to the article "a case of infective endocarditis without detection vegetations after aortic valve replacement" (p-394), a patient underwent aortic root and valve replacement and with a sjm mechanical valve (model/size unknown) secondary to aortic dissection.Two years post surgery, the patient presented to the hospital with repeated fever.Bacillemia was suspected and the patient was hospitalized with levofloxacin (lvfx) treatment.A blood culture test revealed (b)(6).Due to the patient's obese condition and postoperative aortic root replacement, tee and tte images were poor in quality and the presence of vegetation was not be able to be discerned on the aortic valve.Days later, cez and gm were required for diagnosis of ie (major criteria 1 and minor criteria 2 were applied).The patient presented with a cerebral bleed and was diagnosed as ie (major criteria 1 and minor criteria 3).The causal bacteria was (b)(6), however, the infective origin was not identified.Since the patient had just cerebral bleed, medication was tailored to the patient's risk.The patient had a persistent fever and cez+vcm+gm+rfp were administered in addition to rehabilitation which was also started.Two weeks post-hospitalization, a cerebellar infarct and splenic infarct occurred.Approximately 27 days post-hospitalization, gm and vcm were discontinued due to renal failure.Three weeks later, no enrichment bacteria was observed by fdg-pet/ct test.The patient was discharged a month later.The sjm valve remained implanted and no model/serial number was provided.
|