Zusammenfassung
Bei einem 68-jährigen Mann mit Fieber, Schüttelfrost und einem diastolischen Herzgeräusch wurde eine durch Staphylococcus lugdunensis verursachte Aortenklappenendokarditis diagnostiziert. Unter antibiotischer Therapie verbesserte sich das klinische Bild zunächst. Am siebten stationären Behandlungstag wurden große Abszesse mit transösophagealer Echokardiographie nachgewiesen, die sich von der Aortenwurzel bis zur freien Wand des linken Ventrikels ausdehnten. Der notfallmäßige operative Eingriff verlief erfolgreich und eine gerüstfreie Bioprothese wurde implantiert. Staphylococcus lugdunensis verursacht infektiöse Endokarditiden mit aggressivem klinischen Verlauf, die trotz adäquater antibiotischer Therapie zur Destruktion von Herzklappen, Abszedierung und embolischen Komplikationen neigen. Die hohe Letalität bei Patienten unter alleiniger antibiotischer Therapie kann durch frühzeitigen prothetischen Klappenersatz gesenkt werden.
Summary
A 68-year old man with fever chills and a diastolic murmur was diagnosed with aortic-valve endocarditis caused by coagulase-negativeStaphylococcus lugdunensis. The clinical condition initially improved with antibiotic therapy. On day seven, transoesophageal echocardiography revealed large abscesses extending from the aortic root to the left ventricular wall. Emergency cardiac surgery was performed successfully and a stentless bioprosthetic valve was inserted.S. lugdunensis endocarditis is known for its aggressive clinical course with valve destruction, abscess formation and embolic complications despite appropriate antibiotics. Antibiotic treatment alone is associated with a high mortality rate which can be reduced by early valve replacement.
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Petzsch, M., Leber, W., Westphal, B. et al. ProgressiveStaphylococcus lugdunensis endocarditis despite antibiotic treatment. Wien Klin Wochenschr 116, 98–101 (2004). https://doi.org/10.1007/BF03040704
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DOI: https://doi.org/10.1007/BF03040704
Schlüsselwörter
- Infektiöse Endokarditis
- Coagulase-negative Staphylokokken
- Staphylococcus lugdunensis
- intrakardialer Abszess
- transösophageale Echokardiographie