Superior mesenteric artery aneurysm in a patient with infective endocarditis

Abstract

Infective endocarditis (IE) is a rare but serious condition. We present a case of endocarditis in a healthy 40-year-old male with no predisposing conditions. His physical examination was suggestive of peripheral microembolization and prompted us to consider the diagnosis of IE and order the appropriate investigations. After treatment, he later presented to the emergency department with abdominal pain, and a superior mesenteric artery aneurysm was discovered. We discuss recent advances in the changing epidemiology and microbiology of IE, review the presentation and diagnosis of IE, and highlight the potential complications of this disease. RÉ SUMÉL'endocardite infectieuse (EI) est une maladie rare mais grave. Il sera ici question d'un cas d'endocardite chez un homme de 40 ans, auparavant en bonne santé et exempt de facteur de pré disposition. L'examen physique é tait é vocateur d'une micro-embolie pé riphé rique, ce qui a incité à envisager le diagnostic d'EI et à procé der à une exploration approprié e. Aprè s le traitement, le patient est revenu au service des urgences pour des douleurs abdominales, et les examens ont ré vé lé la pré sence d'un ané vrisme de l'artè re mé senté rique supé rieure. Nous ferons donc é tat, dans le pré sent article, des changements observé s dans l'é pidé miologie et la microbiologie de cette affection; passerons en revue le tableau clinique de l'EI et le diagnostic; et ferons ressortir les complications possibles de cette maladie. Keywords: endocarditis, fever, Janeway lesions, Staphylococcus aureusInfective endocarditis (IE) is the inflammation of the endocardium and heart valves caused by bacteria or fungi. It is an uncommon condition with an incidence of between 2 and 10 per 100,000 person-years. Despite advances in diagnosis and treatment, it still has a high mortality rate, with in-hospital mortality of 15 to 20% and 1-year mortality of 20 to 30%. Recent prospective studies show that the epidemiology and microbiology of IE are changing over time. There is a higher rate of diagnosis of health care-associated IE and Staphylococcus aureus IE.1 In the emergency department (ED), key points include maintaining an appropriate index of suspicion in patients with risk factors or specific presentations, performing a thorough history and physical examination, and obtaining blood cultures prior to antibiotic administration if possible. Despite being treated for IE, patients can still present to EDs with relapse and delayed complications of IE. CASE REPORTA 40-year-old previously healthy male presented to our ED with a 1-week history of fever and chills and a 2-day history of pain and redness on his right foot. His only medication was ciprofloxacin, which he had been taking for 6 days. This was prescribed for a presumed urinary tract infection based on complaints of dysuria, urinary frequency, and left flank pain on the second day of illness, which had resolved by the time of representation. He had no other infectious symptoms to account for his fever and no recent travel history. ...