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Na, Cho, Park, Choi, Kim, and Park: Infective Endocarditis: An Autopsy Case Report with Literature Review
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Korean J Leg Med 2014;38(2):78-82.

Published online: 17 January 2014

DOI: https://doi.org/10.7580/kjlm.2014.38.2.78

Infective Endocarditis: An Autopsy Case Report with Literature Review

Joo-Young Na1, Whee-Yeol Cho1, Jeong-Woo Park1, Yoo-Duk Choi2, Hyung-Seok Kim3, Jong-Tae Park3

1Forensic Medicine Division, Gwangju Institute, National Forensic Service, Jangseong-gun, Jeollanam, Korea

2Department of Pathology, Chonnam National University Medical School, Gwangju, Korea

3Department of Forensic Medicine, Chonnam National University Medical School, Gwangju, Korea

책임저자 : 나주영 (515-822) 전라남도 장성군 서삼면 축령 로 687, 광주과학수사연구소 법의학과 전화 : +82-61-393-8442 FAX : +82-61-393-8440 E-mail : pdrdream@gmail.com

Received 7 May 2014       Revised 13 May 2014       Accepted 14 May 2014

Copyright © 2014 The Korean Society for Legal Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

A 69-year-old man was admitted to the hospital because of flu-like symptoms and fatigue for 2 weeks. Computed tomography revealed ground glass opacity and consolidation in both the lungs as well as pleural effusion. The patient was diagnosed with pneumonia and was hospitalized. At the time of hospitalization, he complained of shortness of breath and coughed-up blood-tinged sputum. Two days after admission, he died suddenly. An autopsy was performed; cardiomegaly was noted, and further examination revealed that the aortic valve had been destroyed by multiple, irregular vegetations. Herein, we report an autopsy case of infective endocarditis with a review of the relevant literatures.

Keywords: Key Words :, Infective endocarditis, Forensic, Autopsy

REFERENCES

1. Karchner AW. Infective endocarditis. Kasper DL, Braunwald E, Fauci AS, editors. ed.Harrison’ s principles of internal medicine. 16th ed.New York: McGraw-Hill;2005. p. 731–40.
2. Mylonakis E, Calderwood SB. Infective endocarditis in adults. N Engl J Med. 2001; 345:1318–30.
crossref
3. Na JY, Park JP, Park HJ, et al. The statistical analysis on legal autopsy performed in Korea during 2012 Year. Korean J Leg Med. 2013; 37:198–207.
crossref
4. Byramji A, Gilbert JD, Byard RW. Sudden death as a complication of bacterial endocarditis. Am J Forensic Med Pathol. 2011; 32:140–2.
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5. Zeller L, Flusser D, Shaco-Levy R, et al. A rare complication of infective endocarditis: left main coronary artery embolization resulting in sudden death. J Heart Valve Dis. 2010; 19:225–7.
6. Saad R, Yamada AT, Pereira da Rosa FH, et al. Comparison between clinical and autopsy diagnoses in a cardiology hospital. Heart. 2007; 93:1414–9.
crossref
7. Ferna ′ndez Guerrero ML, A′lvarez B, Manzarbeitia F, et al. Infective endocarditis at autopsy: a review of pathologic manifestations and clinical correlates. Medicine (Baltimore). 2012; 91:152–64.
8. Cohle SD, Graham MA, Sperry KL, et al. Unexpected death as a result of infective endocarditis. J Forensic Sci. 1989; 34:1374–86.
crossref

Fig. 1.
Destroyed aortic cusps and vegetations, measuring up to 1.2 × 0.7 ㎝ are noted. Cross sections of the myocardium show multiple patch-like fibrotic lesions.
kjlm-38-78f1.tif
Fig. 2.
Microscopically, the aortic valve demonstrated friable vegetations comprising fibrin and platelets mixed with inflammatory cells and bacteria (H&E, × 100).
kjlm-38-78f2.tif
Table 1.
Modified Duke Criteria for the Diagnosis of Infective Endocarditis2)
Criteria Comments
Major criteria  
Microbiologic  
 Typical microorganism isolated from two separate blood culture: viridans streptococci, Streptococcus bovis, HACEK group, Staphylococcus aureus, or community-acquired enterococcal bacteremia without a primary focus In patient with possible infective endocarditis, at least two sets of culture of blood collected by separate venipunctures should be obtained within the first 1 to 2 hours of presentation. Patients with cardiovascular collapse should have three cultures of blood obtained at 5- to 10-minute intervals and thereafter receive empirical antibiotic therapy
or
 Microorganism consistent with infective endocarditis isolated from persistently positive blood cultures
or  
 Single positive blood culure for Coxiella burnetii or phase I IgG antibody titer to C. Burnetii > 1:800
Evidence of endocardial involvement
 New valvular regurgitation (increase or change in preexisting murmur not sufficient)		 C. burnetii is not readily cultivated in most clinical microbiology laboratories
or  
 Positive echocardiogram (transesophageal echocardiogram recommended in patients who have a prosthetic vlave, who are rated as having at least possible infective endocarditis by clinical criteria, or who have complicated infective endocarditis) Three echocardiographic findings qualify as major criteria: a discrete, echogenic, oscillating intracardiac mass located at a site of endocardial injury; a periannular abscess; and a new dehiscence of a prosthetic valve
Minor criteria  
 Predisposition to infective endocarditis that includes certain cardiac conditions and infection-durg use Cardiac abnormalities that are associated with infective endocarditis are classified into three groups:
 High-risk conditions: previous infective endocarditis, aortic-valve disease, rheumatic heart disease, prosthetic heart valve, coarctation of the aorta, and complex cyanotic congenital heart diseases
 Moderate-risk conditions: mitral-valve prolapse with valvular regurgitation or leaflet thickening, isolated mitral stenosis, tricuspid-valve disease, pulmonary stenosis, and hypertrophic cardiomyopathy”
 Low- to no-risk conditions: secundum atrial septal defect, ischemic heart disease, previous coronary-artery bypass graft surgery, and mitral-valve prolapse with thin leaflets in the absence of regurgetation
 Fever Temperature > 38℃ (100.4℉)
 Vascular phenomena Petechiae and splinter hemorrhages are excluded
 None of the peripheral lesions are pathognomonic for infective endocarditis
Immnologic phenomena Presence of rheumatoid factor, glomerulonephritis, Osler's nodes, or
Roth spots
Microbiologic findings Positive blood cultures that do not meet the major criteria
  Serologic evidence of active infection; single isolates of coagulase-negative staphylo-cocci and organisms that very rarely cause infective endocarditis are excluded from this category.
Table 2.
Causes of Unexpected Death in Patient with of Infective Endocarditis4)
Cardiac
 Acute congestive cardiac failure
 Heart block
 Fistulae, eg, aorta root to cardiac chamber
 Myocardial infarction
Extracardiac
 Embolic events
  Organ infarction
  Mycotic aneurysm rupture
  Arteriobronchial fistula
 Neurological
  Aseptic or purulent meningitis
  Intracranial hemorrhage
  Embolic stroke
  Seizures
  Encephlopathy
Sepsis
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