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相關文獻
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頁籤選單縮合
題名 | Left-Sided Infective Endocarditis with Bilateral Cerebral Infarctions in an Intravenous Drug Abuser--A Case Report and Literature Review=靜脈藥癮者併發左側感染性心內膜炎及雙側性大腦動脈梗塞--例報告暨文獻回顧 |
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作者 | 楊煦星; 楊俊杰; | 書刊名 | 中華民國重症醫學雜誌 |
卷期 | 7:1 民94 |
頁次 | 頁40-47 |
分類號 | 415.3164 |
關鍵詞 | 感染性心內膜炎; 靜脈藥癮者; 雙側性大腦動脈梗塞; Left-sided infective endocarditis; Intravenous drug abusers; Bilateral cerebral infarctions; |
語文 | 英文(English) |
中文摘要 | 在過去未有使用抗生素的年代,發生感染性心內膜炎之主要原因為風濕性心臟病。但時至今日,一些新的危險因子已然出現,如靜脈藥物之使用、人工瓣膜之植入及洗腎透析。由於感染性心內膜炎,此疾病之早期徵候不明顯,很容易成為急診室的陷阱病例。下文病例中,此患者為一32歲之女性,因發燒兩天嗜睡且意識欠清,而被送至本院急診室來。詢問其過去病史,知其為一靜脈嗎啡藥癮者。經身體檢查發現雙手背,滿是散在性靜脈注射後遺留之結疤傷痕,其他並無異常發現。起初急診室醫師懷疑為中樞神經感染,因此安排腦部電腦斷層檢查,其並無異常發現,而經腰椎穿刺取得之腦脊髓液檢查只呈現白血球稍微偏高。但在此患者住入加護病房後八小時後,其雙手掌、腳掌出現紅色小斑點(典型Janeway’s lesions),及兩側下眼瞼瘀斑等栓塞症候群。其心臟聽診有二級收縮性心雜音,經心臟超音波檢查,偵測到其左心尖瓣膜上,有一10mm大小的贅生物,因此證實是為左側感染性心內膜炎患者。入院三天後,其血液細菌培養為oxacillin resistant staphylococcus aureus。在住院第十天,由於意識程度惡化,經安排腦部電腦斷層檢查,發現有雙側性大腦動脈梗塞。因此,筆者探討此一少見之靜脈藥癮者合併左側感染性心內膜炎及雙測性大腦動脈梗塞病例,並針對感染心性內膜炎做一文獻回顧及探討。 |
英文摘要 | The principal risk factor for infective endocarditis in the pre-antibiotics era was rheumatic heart disease, whereas newer risk factors have emerged including intravenous drug abuse, prosthetic valve replacement, and hemodialysis. Early symptoms and signs of infective endocarditis are not obvious and could deceive physicians in the emergency room. The case described below was a 32-year-old female patient who was brought to our emergency room because of her drowsiness with impaired consciousness for two days. After personal history taking at the emergency room, we knew that she had been an intravenous morphine drug abuser since one year ago. The physical examination just revealed some scars over the dorsum of both hands from scattered needle punctures. After being admitted to the Intensive Care Unit for 8 hours, she showed red spots (typical Janeway’s lesions) on both palms and soles and bilateral conjunctival petechiae, and auscultation revealed a new Grade II systolic murmur suggesting mitral valve insufficiency. For this reason, echocardiography was arranged and it revealed a vegetation 10 mm in size on a mitral leaflet confirming the diagnosis of left-sided infective endocarditis. Her blood cultures drawn on the day of admission grew oxacillin resistant staphylococcus aureus on the third day of admission, and on the tenth day of the admission her brain CT showed bilateral cerebral infarctions predominant on the left side. Infective endocarditis is infrequent. A case is described, and the literature concerning it is reviewed. |
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