Case 5-2014

Baggett, Meridale V; Turbett, Sarah E; Schwartzenberg, Shmuel S.; Stone, James R.

doi:10.1056/nejmcpc1310004

Cited by 5 publications

(1 citation statement)

References 18 publications

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“…[6] In a primary care setting it is important to have a high index of suspicion, and the clinical history of a patient with unexplained high fever should always include asking about possible risk factors such as pre vious cardiac valvular disease, IV drug use, the presence of prosthetic devices (prosthetic valves, orthopaedic hardware), as well as cardiac implantable electronic devices such as pacemakers, which can be possible sources of infection.…”

Section: Clinical Featuresmentioning

confidence: 99%

An approach to a patient with infective endocarditis

Hitzeroth¹,

Beckett

Ntuli

2015

S Afr Med J

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Section: Clinical Featuresmentioning

confidence: 99%

An approach to a patient with infective endocarditis

Hitzeroth¹,

Beckett

Ntuli

2015

S Afr Med J

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An elevated IgG4 response in chronic infectious aortitis is associated with aortic atherosclerosis

2015

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Recently, it was shown that infectious bacterial aortitis can stimulate an elevated IgG4 + plasma cell response in the vessel wall, which could mimic IgG4 aortitis/periaortitis. However, the factors that are associated with an elevated IgG4 + plasma cell response in infectious aortitis are unclear. To ascertain these factors, 17 cases of infectious aortitis and 6 cases of non-infectious severe abdominal aortic atherosclerosis were assessed for the magnitude of IgG4 + plasma cell response. The degree of IgG4 + plasma cell infiltration was determined by immunohistochemistry. Infectious cases were subcharacterized as chronic (43 weeks duration) or acute ( o3 weeks duration) based on the duration of symptoms, and as involving either the ascending aorta or the distal aorta, ie, the descending thoracic and/or abdominal aorta. There was a 5-16-fold greater degree of IgG4 + plasma cell infiltration in the chronic distal infectious aortitis group compared with the other three infectious aortitis groups (P ≤ 0.0007), and compared with non-infectious severe abdominal aortic atherosclerosis (Po 0.0008). This resulted in a greater IgG4/IgG ratio in the chronic distal infectious aortitis group compared with the acute ascending and acute distal infectious aortitis groups (Po 0.03). The degree of IgG4 + plasma cell infiltration in chronic distal infectious aortitis overlaps with that seen in the aortitis and periaortitis of IgG4-related disease. In the chronic infectious aortitis cases, the degree of IgG4 + plasma cell infiltration was more intense in patients with moderate to severe aortic atherosclerosis compared with those patients with less aortic atherosclerosis (P = 0.007). These findings indicate that an elevated IgG4 + plasma cell response occurs in the descending thoracic and abdominal aorta in the setting of chronic bacterial infectious aortitis and pre-existing atherosclerosis. This inflammatory response to chronic infection in atherosclerosis-laden aortas may have implications for the development of IgG4-rich inflammatory atherosclerotic aortic aneurysms.

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Case 5-2014: A Man with Fever, Thrombocytopenia, and Renal Failure

2014

N Engl J Med

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Case 5-2014

Abstract: A 59-year-old man was admitted to this hospital because of fever, confusion, rash, thrombocytopenia, and renal failure, 10 days after a hunting trip in the Nevada valley. Diagnostic procedures were performed, and diagnostic test results were received from another hospital.

Cited by 5 publications

References 18 publications

An approach to a patient with infective endocarditis

An approach to a patient with infective endocarditis

An elevated IgG4 response in chronic infectious aortitis is associated with aortic atherosclerosis

Case 5-2014: A Man with Fever, Thrombocytopenia, and Renal Failure

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