Infective Endocarditis Fall 2012

Chills and fatigue that have been worsening over the

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chills, and fatigue, that have been worsening over the past few days. He also states that he has developed a rash all over his stomach and painless red spots on his toes. He states that he had some dental work done one week ago and did not take any antibiotics prior to or after this procedure. He denies illicit drug use. Vitals are BP 110/70, HR 98, RR 14, T 100.2F, Wt 80 kg. Pertinent labs include SCr 0.8 mg/dl, WBC 9,000/mm3, Hgb 11.2 g/dl, Hct 33%, Plt 173,000/mm3. Blood cultures are immediately drawn. A stat TEE is performed which reveals a large vegetation on the mitral valve.
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Case 1 What risk factors does this patient have for IE? What signs/symptoms does this patient have that are consistent with IE? What is/are the most likely organisms causing this patient’s IE?
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Case 2 A 24 yo male presents to the ED complaining of fever, chills, N/V, and anorexia. He has no significant PMH. He is homeless and an IVDA (heroin) for the past year but claims to have quit 1 week ago. On physical exam, he has (+) Janeway lesions, (-) Osler nodes, and (+) splinter hemorrhages under his fingernail beds. His vitals are BP 115/80, HR 115, RR 12, T 102.1F, Wt 73 kg. He has a faint systolic ejection murmur. Pertinent labs include SCr 0.7 mg/dl, WBC 15,000/mm3, Hgb 13 g/dl, Hct 39%, Plt 110,000/mm3. A TEE reveals a vegetation on the tricuspid valve. Blood cultures are growing Gram-positive cocci in clusters.
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Case 2 What risk factors does this patient have for IE? What signs/symptoms does this patient have that are consistent with IE? Would he be considered to have left- or right-sided IE? What is/are the most likely organisms causing this patient’s IE?
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Case 3 A 68 yo male presents to the ED complaining of fever and N/V worsening over the past few days. His PMH is significant for HTN, HL, CHF, prostate cancer, mitral valve replacement (2006) due to previous IE. He states his symptoms started about 1 week after after he had his prostate removed via transurethral resection (TURP), which was 3 weeks ago. On physical exam, he has (-) Janeway lesions, (+) Osler nodes, and (+) splinter hemorrhages under his fingernail beds. His vitals are BP 138/88, HR 110, RR 18, T 100.8F, Wt 84 kg. Pertinent labs include SCr 1.2 mg/dl, WBC 14,000/mm3, Hgb 12 g/dl, Hct 34%, Plt 94,000/mm3. A TEE reveals a vegetation on the prosthetic mitral valve. Blood cultures are growing Gram-positive organisms in pairs and chains.
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Case 3 What risk factors does this patient have for IE? What is/are the most likely organisms causing this patient’s IE?
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chills and fatigue that have been worsening over the past...

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