case presenation

Endocarditis

Chief complaints (CC)
Fever, poor appetite, upper abdominal pain
History of present illness (HPI)
47 YR old female has fever for the last 3 w. chills & rigors poor appetite , wt loss , fatigue upper abdominal pain lt ankle pain & swelling
Past medical history (PMHx)
CRF for the last 4 yrs on regular HD No DM , HTN NO previous heart disease cholecystictomy
Allergies
none known.
Current medications
oscal , neurobion , lanzoprazol motilium
Social history (SocHx)
denies smoking.
Family history (FHx)
nothing relevant
Physical examination (PE)
BP 110/70 , PR 100 bpm , Tem 38
H&N ; pale , no LN enlargement
Chest ; clear
Heart ; reg. s1 s2 , ESM & EDM at LSB , LSM at apex
Abd. ; LUQ tenderness
Extrem. ; lt ankle swelling , no skin leasions
Laboratory results (Lab)
Hb 9.3 , WBC 12.9 , PLT 341 CR 5.6 , Na 129 , K 4.0 , RBS 135 CRP 341 ,ESR 120 LFT ; normal urine ; +1 protein , +2 blood , 10-12 WBC , 20-24 RBC
Other investigations
CXR ; slight cardiomegally
EKG ; s.tachycardia
U/S abd. ; normal
TTE ; +2 MR , +2 AI , mild AS with PG 25 EF 65 % , NO vegitations
TEE ; vegitation over the rt coronary cusp of the AV
Blood C&S ; enterococcus sensitive to ampicillin & vancomycine
Case summary and impression
diagnosis> infective endocarditis
Treatment
ampicillin 2 gm I.V BID & gentamicin 120 mg after each dialysis
Follow up
ECHO, blood, lab
Discussion
Vegetation is the characteristic lesion ( a mass of plt & fibrin in which abundant microorganisms & inflammatory cells are engorged ) Valves are most commonly involved , however , infection may occur at sites of septal defect, on chordae tendineae , mural endocardium ,PDA , coarctation of aorta

in brief

Patient 47 years, Female