A Case of Early Valve Replacement for Haemophilus parainfluenzae Endocarditis Complicated with Acute Cerebral Infarctions

Myung Ho Kang; Kyoung Ree Lim; Tae Suk Kim; Se Hyeon Kim; Gyeong Hyeon Kim; Won Sup Oh; Kilsoo Yie

doi:10.3947/ic.2011.43.3.270

Journal List > Infect Chemother > v.43(3) > 1035091

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Kang, Lim, Kim, Kim, Kim, Oh, and Yie: A Case of Early Valve Replacement for Haemophilus parainfluenzae Endocarditis Complicated with Acute Cerebral Infarctions

Case Report

Infection & Chemotherapy

Infection & Chemotherapy 2011; 43(3): 270-274.

Published online: 29 June 2011

DOI: https://doi.org/10.3947/ic.2011.43.3.270

A Case of Early Valve Replacement for Haemophilus parainfluenzae Endocarditis Complicated with Acute Cerebral Infarctions

Myung Ho Kang¹, Kyoung Ree Lim¹, Tae Suk Kim¹, Se Hyeon Kim¹, Gyeong Hyeon Kim¹, Won Sup Oh¹, Kilsoo Yie²

¹Department of Internal Medicine, Kangwon National University School of Medicine & Hospital, Chuncheon, Korea.

²Department of Cardiothoracic Surgery, Kangwon National University School of Medicine & Hospital, Chuncheon, Korea.

Correspondence to Won Sup Oh, M.D., Ph.D. Division of Infectious Diseases, Department of Internal Medicine, Kangwon National University School of Medicine & Hospital, 26 Kangwondaehak-gil, Chuncheon 200-947, Kangwon-do, Korea. Tel: +82-33-258-9466, Fax: +82-33-258-9471, wsoh@ymail.com

Received 24 December 2010 Revised 18 March 2011 Accepted 24 March 2011

(open-access):

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

Haemophilus parainfluenzae, one of the member of the HACEK group of gram-negative oropharyngeal species, is a rare cause of subacute native valve endocarditis. Infective endocarditis caused by H. parainfluenzae appears to carry a high incidence rate of cerebral embolism, often making the timing of surgical intervention difficult. A 52-year-old male was diagnosed with acute endocarditis caused by H. parainfluenzae complicated with acute cerebral infarctions. After institution of antibiotic therapy, this patient was mechanically ventilated because of the sudden onset of dyspnea. Repeated two-dimensional echocardiography demonstrated rate-dependent mitral stenosis without interval change of vegetations on the mitral valve. Making a decision regarding the timing of surgical intervention was difficult because of a fear of clinical deterioration after early valve replacement.

Keywords: Bacterial endocarditis, Haemophilus parainfluenzae, Cerebral infarction, Mitral valve stenosis, Heart valve prosthesis implantation

Figures and Tables

Figure 1

Diffusion weighted magnetic resonance imaging of the brain on hospital day 1. Multiple high intense lesions were seen on both cerebral hemispheres, suggesting acute cerebral infarctions.

Figure 2

Radiographic findings of the chest on day 1. (A) Posteroanterior view at the emergency department. (B) Anteroposterior view just after endotracheal intubation, suggesting pulmonary edema.

Figure 3

Operative finding of mitral valve area on hospital day 4. A large-sized (15×15 mm) vegetation, indicated by the black arrow, is observed on posterior mitral leaflet. Several small vegetations, indicated by the white arrow, are evident on the anterior mitral leaflet.

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