Fatal septicemia in a patient with cerebral lymphoma and an Amplatzer septal occluder: a case report

Abstract

IntroductionThe Amplatzer septal occluder is frequently used for percutaneous closure of an atrial septal defect. Complications include thrombosis and embolism, dislocation, cardiac perforation, and, rarely, infection. We report the case of a patient who had survived an occluder-related thromboembolism two years previously.Case presentationA 72-year-old Caucasian woman had received a septal occluder because of an atrial septal defect seven years ago. Two years ago, she underwent chemotherapy of a non-Hodgkin lymphoma, developed atrial fibrillation, and experienced a left-sided occluder thrombosis with stroke and peripheral embolism. Now, she presented with cerebral lymphoma, received glucocorticoids, and subsequently developed skin lesions. Swabs from the lesions and blood cultures were positive for methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa. Endocarditis, however, was considered only two months later and echocardiography suggested aortic valve endocarditis. Despite antibiotic therapy, she died three days later because of septicemia, and no post-mortem investigation was carried out. It remains uncertain whether the septal occluder was endothelialized or infected and whether explantation might have changed the outcome.ConclusionsIf infections occur in patients with a septal occluder, endocarditis should be considered and echocardiography should be performed early. To prevent a fatal outcome, explantation of the septal occluder should be considered, especially in patients with problems that suggest delayed endothelialization. Post-mortem investigations, including bacteriologic studies, should be carried out in patients with a septal occluder in order to assess the focal and global long-term effects of these devices.

Late infective endocarditis of an Amplatzer atrial septal device twelve years after implantation

“…Radiológ Kurt Amplatz uviedol Amplatzerov okluzor do praxe v roku 1997 v Minnesote [7]. Komplikácie implantácie Amplatzerovho okluzora zahŕňajú trombózu a embóliu, dislokáciu, perforáciu srdca a zriedkavo infekčnú endokarditídu (IE) [8].…”

“…prezentujú, že do roku 2011 bolo publikovaných len šesť kazuistík prezentujúcich IE Amplatzerovho okluzora a Aruni a spol. poukazujú len na dva prípady neskorej IE okluzora do roku 2013 [8,9]. Ďalšími možnými komplikáciami Amplatzerovho okluzora sú poruchy rytmu srdca s incidenciou 5,2 až 6,1 % [10,11].…”

“…prezentujú nárast IE spôsobenej Staphylococcus aureus počas dvoch dekád z 2 % (1990) na 25 % (2009) [16]. Kazuistiky zamerané na IE okluzorov prezentujú hubovú endokarditídu v dvoch prípadoch, zatiaľ čo v iných siedmich prípadoch považujú za etiologického činiteľa baktérie [8,9,[17][18][19][20][21][22][23]. Tri práce prezentujú pozitivitu hemokultúr na Staphylococcus aureus [9,[21][22].…”

“…ďalej prezentujú Streptococcus pyogenes ako etiologický činiteľ IE okluzora u dieťaťa [23]. Iná práca prezentuje dvojnásobnú pozitivitu hemokultúr na Staphylococcus aureus aj Pseudomonas aeruginosa [8].…”

“…Ďalšie dve práce taktiež zdôrazňujú nedostatočné endotelizáciu Amplatzerovho okluzora extrahovaného z dôvodu IE [19,21]. Iný autori publikovali v roku 2011 prácu prezentujúcu pacienta so vznikom fi brilácie predsiení 58 mesiacov po implantácii Amplatzerovho okluzora s jeho trombózou a následne po dvoch rokoch IE aortálnej chlopne s hemokultúrou pozitívnou na Staphylococcus aureus [8]. Jha et al ďalej prezentujú prácu desať ročného pacienta s IE Amplatzerovho okluzora šesť rokov po jeho implantácii [23].…”