Multiple embolization in infective endocarditis

A 67-year-old man presented to the emergency department with back pain, fever, and confusion. Suspecting of a meningoencephalitis, he was admitted and started on antibiotics. Vertebral MRI and lumbar puncture supported this initial hypothesis, while blood cultures resulted positive for a meticillin-sensitiveStaphylococcus aureus. On Day 3, a progressive neurological decline associated with multi-organ failure needing endo-tracheal intubation become evident. Cerebral contrast MRI showed small bilateral cortical microabscesses and subarachnoid haemorrhages (Panel A). Total body CT scan detected diffuse septic pulmonary infarcts as well (Panel B). On a clinical ground, peripheral embolic lesions were clear starting as Janeway lesions and evolving in diffuse finger ’s necrosis (Panel C). Roth ’s spots retinal haemorrhages were evident. Transoesophageal echocardiography confirmed a vegetation of the mitral valve (Panel D) that was interpreted as the original septic focus. Surgical valve replacement was indicated as urgent treatment and prolonged antibiotic therapy with floxapen is ongoing.
Source: European Heart Journal - Category: Cardiology Source Type: research

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Conclusions: Older adults who begin using cannabis are likely using for what they perceive to be medicinal purposes for a range of issues. However, they receive minimal guidance from their family physicians and instead obtain information from non-clinician sources.Clinical implications: Cannabis screening should be included in geriatric assessments and medicine reconciliation. Continuing education for clinicians needs to address knowledge gaps about cannabis use among older adults. PMID: 32223535 [PubMed - as supplied by publisher]
Source: Clinical Gerontologist - Category: Geriatrics Tags: Clin Gerontol Source Type: research
Conclusions: Continuing shifts in society's cultural landscape, ongoing emphasis on value versus volume, and other industry fiscal imperatives continue to evoke an evolution in end-of-life care. The attainment of successful outcomes by professional case managers with those populations will be dependent on awareness and comprehension of regulations, legislation, and reimbursement; the influences of ongoing industry trends; availability of emerging resources; and ongoing technological advances. Ethical excellence remains at the core of case management across the interprofessional workforce and the transitions of care. Imp...
Source: Professional Case Management - Category: Health Management Tags: Articles Source Type: research
Abstract Osteoarticular infections (OAIs) in the setting of infective endocarditis (IE) are uncommon. Although morbidity and mortality have been widely studied, details of the characteristics of patients with concurrent IE and OAI are limited. Therefore, the purpose of this study was to determine the (1) incidence, (2) mortality, (3) clinical features, and (4) microbiological profiles of OAIs in the setting of IE. A retrospective review was conducted of 1280 IE cases at a large academic institution between 2009 and 2015. Patients were categorized according to the following OAI types: spondylodiskitis, large joint ...
Source: Orthopedics - Category: Orthopaedics Authors: Tags: Orthopedics Source Type: research
Publication date: Available online 23 April 2019Source: Interdisciplinary NeurosurgeryAuthor(s): Kyle P. O'Connor, Gina S. Perez, Bappaditya Ray, Jo Elle G. Peterson, Bradley N. BohnstedtAbstractA 62-year-old woman with history of chronic back pain and vertebral osteomyelitis presented with right hemiparesis and aphasia with last known well 10 h prior to presentation and a CT angiography demonstrating a left M1 occlusion. A thrombectomy was performed with resultant TICI-2b improving NIHSS from 28 pre-thrombectomy to 19 post-thrombectomy. Pathologic examination of the embolus demonstrated abundant bacterial colonies. Whil...
Source: Interdisciplinary Neurosurgery - Category: Neurosurgery Source Type: research
“Good morning, Mr. S! How are you feeling today?” I ask as I step into his hospital room. Yesterday, Mr. S was admitted for infective endocarditis and has been tolerating antibiotic treatment well. I am a medical student on my acute cardiology rotation taking care of him. “I’m feeling fine,” he says, and I proceed to ask about how he slept, if he’s experiencing any chest pain, palpitations, shortness of breath, abdominal pain, or problems going to the bathroom. He seems to have all these answers memorized, saying no to my questions. I perform a physical exam and decide that he is doing a...
Source: Kevin, M.D. - Medical Weblog - Category: General Medicine Authors: Tags: Education Cardiology Hospital-Based Medicine Source Type: blogs
LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog Welcome to the 315th LITFL Review! Your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chunk of FOAM. The Most Fair Dinkum Ripper Beauts of the Week Rob Macsweeney of Critical Care Reviews posts the 2 hour livestream of the ADRENAL...
Source: Life in the Fast Lane - Category: Emergency Medicine Authors: Tags: Education LITFL review Source Type: blogs
We present a case of endocarditis caused by Granulicatella adiacens and Sjögren’s syndrome (SS) with oral complications diagnosed simultaneously. A 67-year-old woman was admitted to our hospital with fever, general fatigue, arthralgia, and back pain. She was diagnosed with primary SS according to the criteria of the American-European Consensus Group. Transthoracic echocardiography carried out to examine her persistent fever revealed vegetation formation (14×5mm) on the aortic valve and her blood cultures were positive for G. adiacens. According to modified Duke’s criteria, she was also diagnosed with...
Source: IDCases - Category: Infectious Diseases Source Type: research
We present the case of a male who presented with limb vein thrombosis, fatigue and a history of back pain. The computed tomography scan revealed a saccular aneurysm and combined vertebral osteomyelitis of the 3rd lumbar vertebra.
Source: Annals of Vascular Surgery - Category: Surgery Authors: Source Type: research
We present the case of a male who presented with limb vein thrombosis, fatigue, and a history of back pain. The computed tomography scan revealed a saccular aneurysm and combined vertebral osteomyelitis of the third lumbar vertebra.
Source: Annals of Vascular Surgery - Category: Surgery Authors: Tags: Case Report Source Type: research
We present the case of a male who presented with limb vein thrombosis, fatigue, and a history of back pain. The computed tomography scan revealed a saccular aneurysm and combined vertebral osteomyelitis of the third lumbar vertebra.
Source: Annals of Vascular Surgery - Category: Surgery Authors: Tags: Case Report Source Type: research
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