An adult over 61 years old, with a history of hypertension, had been admitted to the Neurology Department three weeks before with the diagnosis of Transient Ischemic Attack (TIA).
At home, however, the patient developed fever and, one week after admission, she was hospitalized for a second TIA.
On this occasion and given its febrile course, the patient was evaluated by the Department of Infectious Diseases.
She did not have common risk factors for developing constipation, but approximately 1.5 months earlier, she had undergone a CA due to chest pain of unknown cause.
His physical examination revealed fever of 39.7°C accompanied by solemn chills, loss of motor function in grade 3/5 of the upper and lower right lower extremities low systolic border, palpable liver border.
There were no peripheral stigmata.
Laboratory tests showed white blood cell count of 19.870/mm3, hemoglobin of 10.9 g/dL, CRP of 31 mg/dL, creatininemia 1.3 mg/dL.
The rest of the chemical tests were normal.
Having obtained blood cultures, a combined antibiotic therapy of cefepime and amikacin was initiated, considering the history of hospitalization in the previous month.
A TTE demonstrated the existence of a 12 x 6 mm freely mobile vegetation adhered to the mitral valve, together with a certain degree of mitral regurgitation.
P. aeruginosa was isolated in all hemocultives three days after inoculation.
It was found that this strain had the same antibiogram as patient 1.
Ongoing antibiotic therapy was maintained and a reduction in vegetation size was observed in an echocardiographic control.
However, on day 24 of antibiotic therapy, the patient presented signs of acute heart failure.
She was admitted to the intensive care unit (ICU) and supported with mechanical ventilation.
He underwent cardiac surgery with mitral valve replacement.
Ten days after surgery, the patient developed cardiac arrest, draining abundant fluid.
The patient's clinical condition improved, but 16 days after this surgery, the fever reappeared, accompanied by leukocytosis, purulent respiratory secretion, and massive pleural effusion.
Treatment was switched to meropenem and left atrial septal defect was diagnosed.
The existence of pneumonia associated with mechanical ventilation by Acinetobacter baumannii was confirmed.: The clinical and hemodynamic condition of the patient worsened and finally died.
