Male patient, 60 years old, with Björk-metallic mitral valve stenosis and congestive tricuspid annuloplasty 20 years ago for rheumatic heart valve disease, chronic atrial fibrillation NYHA I, hypertension
He was treated with acenocoumarol.
She was admitted to our service due to fever, chills and worsening of her habitual dyspnea, with the appearance of orthopnea and edema in the lower limbs.
Clinical examination was compatible with CHF (swollen jugular veins, arrhythmic pulse at 100bpm, gallop rhythm, bilateral basal pulmonary crepitants, and hepatomegaly of the lower limbs).
Laboratory tests showed a hemoglobin of 12.4 g/L, leukocytes 17.810/ml, with 87% neutrophils, and the rest of the usual parameters were within normal limits.
The chest X-ray showed signs of CHF.
Serial hemocultives were performed in which Neisseria Sicca was persistently isolated, so treatment with intravenous sodium penicillin G was initiated 24 million units in continuous perfusion and the first patient afentamicin I.
(4) During admission, red and painful lesions appeared in the finger pulps of both hands compatible with vasculitic phenomena, performing, therefore, the diagnosis of Endocrinitis according to clinical criteria.
Transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) showed a normal functioning mitral prosthesis and absence of vegetations.
On the 9th day of treatment the patient presented a sudden episode of loss of strength in the left hemibody, visualized in a cranial CAT scan with hyper-occipital foci compatible with temporal-parietal and hemorrhagic level 3.
At that time in I.N.R. it was 2.45, although anticoagulation was discontinued.
Four days later, and after patient stabilization, it was decided to restart anticoagulation with intravenous heparin sodium, completing 6 weeks of antibiotic treatment and heparin.
The control brain CT after treatment showed persistent occipitoparietal hematoma, with other hemorrhagic foci.
If signs and symptoms persist, discontinue Viraferon therapy and institute appropriate medical therapy.
