Request PDF on ResearchGate | On Jul 1, , Meritxell Mellado Joan and others published Aneurismas micóticos de ambos miembros inferiores secundarios. El aneurisma micótico es una causa rara y potencialmente letal si no se diagnostica de forma precoz; es la infección total de la pared arterial. [ ]. La mortalidad secundaria a un vasoespasmo e infarto cerebral consiguiente es del los aneurismas micóticos, las vasculitis no infecciosas, el tumor cerebral.
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Mycotic aneurysm as a complication of infective endocarditis – a case report.
Hypertensive and hypothyroid patient, treated with captopril 25 mg T. Underwent thyroidectomy 8 months before admission for adenomatous goiter. Patient denies allergies and previous hospitalization. In the lung auscultation, vesicular murmur present and symmetrical, with no adventitious sounds.
The presence of lesions compatible with Janeway lesions on the right fifth toe was verified. No signs of meningeal irritation and no focal deficits.
Aneurisma micótico da artéria radial secundário a endocardite Por streptococcos bovis
Additional tests were requested: Given the findings, IE diagnosis was established based on the modified Duke criteria two major and one minor. On the fifty-seventh day of hospitalization, the patient had an episode of generalized tonic-clonic seizures associated with decreased level of consciousness – with no eye opening, issuing incomprehensible sounds and decorticate response to painful stimuli Glasgow Orotracheal intubation was then implemented.
In cranial tomography performed after the event, the presence of acute subdural hematoma was found on the frontoparietal subdural hematoma to the left with a subjacent frontoparie-tal focus of contusion.
The patient was sent for an emergency decompressive hemicraniectomy.
After the procedure, the patient was referred to the Intensive Care Unit at the hospital. On the sixty-seventh day of hospitalization orotracheal extubation was performed, and after three days the patient was then referred to clinical medicine ward. The patient initially remained aphasic, but presented progressive improvement with multi-professional rehabilitation.
The patient was discharged on the ninety-fifth day of hospitalization with moderate disability grade 3 on the modified Rankin scale9 after completing 42 days of treatment with the latest antimicrobial scheme.
They were referred for monitoring by hepatitis and cardiology outpatient clinics with valvuloplasty scheduled. The patient underwent skull reconstruction 60 days after discharge, with no adverse events.
The case reported is consistent with the reality of IE in medical practice in various aspects. The patient, aged 47, and with native valves is categorized under the new epidemiological profile of the disease, which was previously reserved for patients with compromised valves and young adults.
However, the entry point that could have caused bacteremia was not identified, as cdrebrales possible in the majority of cases. The patient sought the health service with specific complaints, presenting a physical exam with various signs of cardiovascular impairment.
Micotiocs paradox is not frequent, but possible, considering the presence of underlying heart disease and the characteristics of the patient. In the present case, the exam was capable of showing mitral valve vegetation, at cedebrales location most commonly affected by IE.
In relation to the blood culture, the case presented differs from European studies where 2. After almost two months of clinical evolution the patient presented a mycotic aneurysm, as a consequence of displacement of septic emboli from valvular vegetation to the arterial vasa vasorumdisseminating the infection to the inner layer and wall of the vessel.
The cerebral hemorrhage presented by the patient can be justified by the fact that mycotic aneurysms generally present a fine and fragile wall.
In addition to the difficulty in diagnosis, the treatment of this complication does not yet have defined protocols, which makes conduct individualized and based on the clinical symptoms of the patient, as well as on the cost-benefit analysis of the treatment strategies. The long period of hospitalization of the patient nearly days may be explained by the occurrence of cerebral hemorrhage, corroborated by the study conducted in northeastern Italy, which demonstrates an increase in the average hospitalization from 23 to 35 days in the presence of complications associated with IE.
Emerging issues in infective endocarditis. Towards a history of infective endocarditis. Epidemiology, characteristics, and outcome of infective endocarditis in Italy: Italian study on endocarditis. Diagnosis and management of infective endocarditis and its complications.
Endovascular treatment for intracranial infectious aneurysms
Embolic events and neurological complications in infective endocarditis. New criteria for diagnosis of infective endocarditis: Improving the assessment of outcomes in stroke: Guidelines on the prevention, diagnosis and treatment of infective endocarditis. Infective endocarditis-prophylaxis, diagnostic criteria, and cerebfales. Medicina B Aires ; Vascular complications of infective endocarditis. Infective endocarditis with cerebrovascular complications: Interact Cardiovasc Thorac Surg.
Early and mid-term outcomes following surgical management of infective endocarditis with associated cerebral complications: Neurologic complications cerebbrales outcomes of infective endocarditis in critically ill patients: Increasing incidence and mortality of infective endocarditis: This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Services on Demand Journal. Discussion The case reported is consistent with the reality of IE in medical practice in various aspects. How to cite this article.