A turbulent cause of bilateral pneumonia

Abstract

A 62-yr-old female presented with complaints of progressive chest pain, increasing in severity with inspiration, a productive cough and fever for 2 days. Moreover, she had lost 12 kg in weight in the last 3 months and was experiencing night sweats. During this period, she had a folliculitis in her axilla. Her medical history yielded diabetes mellitus type II, hypertension and anaemia. Transthoracic echocardiography, performed 4 years ago, had shown flow abnormalities in the pulmonary artery and left ventricular volume overload. The patients' medication included metformin, insulin, hydrochlorothiazide, simvastatin, metoprolol, ferrofumerate and vitamin B.On physical examination, a pale and cachectic patient was seen. Her body temperature was 39uC, with a heart rate of 104 beats?min -1 , respiratory rate of 20 breaths?min -1 and blood pressure of 160/65 mmHg. Chest auscultation revealed normal breath sounds, a 2/6 systolic murmur in the right parasternal area and a 1/6 continuous murmur in the left parasternal area. Otherwise, physical examination was normal.An overview of investigations is presented in table 1. A chest radiograph was performed upon admission ( fig. 1) and a contrast-enhanced computed tomography (CT) scan was performed before and after treatment (figs 2 and 3, respectively). A CT scan was also obtained in the parenchymal setting ( fig. 4).

Echocardiographic findings in patent ductus arteriosus-associated infective endarteritis

“…Associated cardiovascular defects were rarely reported in patients with endarteritis because of PDA. Only three patients were found in 24 publications (pulmonary stenosis, coarctation of the aorta, and rheumatic valve disease) (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). It is worth noting that subvalvular aortic stenosis was present in three of the 17 patients in our study group.…”

Ductus arteriosus‐associated infective endarteritis: Lessons from the past, future perspective

“…Most case reports include patients with an isolated PDA, not associated with other types of CHD or previous cardiac surgery, except one case, where the PDA‐IE involves the pulmonary valve. As in the majority of case reports on PDA‐IE, the origin of the bacteremia was unclear in our patient. Whether the mild redness of the umbilicus before hospital admission was a skin infection and therefore responsible for bacterial entrance remains open.…”

“…19 Therefore, some controversy exists regarding the need for routine closure of a silent or hemodynamic irrelevant PDA for the sole purpose of eliminating the risk of PDA-IE. 1,37 In fact, the development of PDA-IE seems to be more frequent in patients with a hemodynamic relevant PDA, [3][4][5][6][7][8][9][10][11][12][13][14][15]18,19 while only anecdotic cases of PDA-IE in a hemodynamic irrelevant PDA are reported. 11,16,24,29,38,39 Only few reports of a PDA-IE in young infants have been published, 15,19,29,39 but due to the increasing number of very low birth weight preterms, where a PDA is a frequent finding, this infective complication has to be kept in mind.…”

“…According to our literature review (Table ), the typical presentation of a PDA‐IE is characterized by prolonged fever (for weeks or even months), sometimes associated to clinical signs of an hemodynamic relevant PDA (fatigue, heart failure, anorexia) or of complications of a PDA‐IE such as septic pulmonary or systemic embolisms. Most case reports include patients with an isolated PDA, not associated with other types of CHD or previous cardiac surgery, except one case, where the PDA‐IE involves the pulmonary valve.…”

“…The ductus arteriosus Botalli connects the descending aortic arch with the roof of the main and left pulmonary artery and serves as an obligatory right‐to‐left shunt during fetal life. Since first successful surgical ligation of a patent ductus arteriosus (PDA) in 1938 and the establishment of medical and interventional techniques for PDA closure, infective endarteritis in patients with a PDA is a rare or even disappearing clinical entity in developed countries and only described in cases reports and one retrospective study with vegetations related to hemodynamic relevant or less relevant PDA found either in postmortem studies or echocardiographic evaluations. However, in developing countries a PDA remains a predisposing risk factor for IE …”