A 77-year-old retired man was admitted to our hospital with a diagnosis of febrile syndrome under study.
She had a history of operated aortic coarctation, aortic valve replacement 40 years ago, composite aortic valve replacement and ascending aorta replacement, and mitral valve replacement three years ago, so she was on oral anticoagulant therapy.
He also had hypertension, secondary heart failure and hypothyroidism in control.
She presented intermittent fever for one month of evolution, quantified up to 38 °C axillary, associated with moderate diffuse abdominal pain, nonspecific, night sweats and weight loss of 6 kg in the last month.
No diarrhea, vomiting, cough, dysuria, arthralgia or skin lesions.
As part of the epidemiological background, he sought treatment in Santiago and had not traveled abroad.
At the time of evaluation, the patient was conscious, alert, cooperative, with stable hemodynamics, flat jugular veins and without palpable lymph nodes.
The pulmonary examination was normal, the heart examination showed a systolic murmur in aortic focus 3/6, the abdomen was blushing, depressing, diffusely sensitive to irritation, and no signs of peritoneal irritation.
The lower limbs did not present edema, and the skin and neck had no lesions.
The eye fundus was normal.
Laboratory tests were performed, highlighting a normal complete urine test and renal function, blood count with normocytic normochromic anemia (hemoglobin 11 gr/dL and hematocrit 31.7%), with the other normal series INR 15.3 mg/dL.
Liver tests were requested due to the pain picture: AST 45 IU/L, ALT 81 IU/L, total bilirubin 0.69 mg/dL, LDH 360 U/L, normal ALT, and alkaline phosphatases.
Serology for hepatitis A, B and C virus and HIV were negative, negative Widal reaction, normal upper endoscopy and abdominal ultrasound showed no abnormalities.
Among other tests, TSH 0.84 U/ml (VN 0.3-4.2 U/ml) and negative rheumatoid factor were highlighted.
Due to the persistence of the condition, the patient was admitted and the study was continued with a normal AP and lateral chest X-ray.
Due to the history of a prosthetic valve, a transesophageal echocardiogram showed a philate image of 20 x 8 x 5 mm in the aortic valve.
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Empirical treatment was initiated for vancomycin associated with prosthetic valve IV 1 g twice daily, gentamicin 80 mg three times daily and rifampicin 600 mg daily.
The two blood cultures taken prior to the start of antibacterial treatment were positive at 23 hrs. to a gram-positive bacillus, which was identified as L.
Treatment was adjusted to ampicillin 2 g iv, six times a day and gentamicin 80 mg three times a day.
Due to a good clinical response, the patient was discharged and continued on an outpatient basis with intravenous antibacterial treatment.
It was monitored monthly during the first three months, then every three months until completing one year and then every six months during the second year.
During follow-up, a decrease in inflammatory parameters was observed and the doses of antibacterial agents were adjusted according to their renal function.
She completed three weeks of treatment with gentamicin 80 mg twice a day, suspended due to deterioration of renal function; ampicillin 2 g, four times a day amoxicillin for twelve weeks and then she received residual lesion treatment with amoxicillin twice a day.
The last control echocardiogram showed no significant variations with respect to the initial examination.
Currently, the patient has remained asymptomatic.
