A 64-year-old older adult was admitted to our hospital with a history of recurrent fever, weight loss and increased fatigue.
His physician included hypertension.
The patient had relative risk factors including cardiac murmur, cardiac valve disease and recent dental interventions.
Only one month before this hospitalization, an outpatient CA due to angina had been performed.
fever of unknown origin was present.
Relevant findings on physical examination were a temperature of 38.8°C and a pansystolic ejection murmur on the apex.
A transthoracic echocardiography (TTE) was performed immediately, detecting a vegetation of 12 x 9 mm attached to the anterior leaflet of the mitral valve, and a posterior leaflet protruding into the left atrium.
Laboratory tests showed leukocyte count 15.800/mm3, hemoglobin 1 g/dL, CRP 15.55 mg/dL, and the remaining tests, including C3 and C4, were normal.
Urine analysis revealed erythrocytes 10-15 and leukocytes 8-10 per field, with absence of bacteria.
An abdominal ultrasound was normal.
Blood and urine cultures were obtained at the time the patient was admitted. Treatment with ampicillin 8 g/day was initiated empirically, as well as gentamicin diagnosis with ampicillin 1 mg/kg/day, and
The four blood cultures were positive for P. aeruginosa sensitive to all anti-pseudotumor agents.
Antimicrobial therapy was then adjusted to 3 g/day ceftazidime and 1 g/day amikacin.
The fever resolved completely on day 4 of this second treatment.
CRP was normalized during the third week of antibiotic therapy. Control blood cultures were negative.
TTE was repeated weekly during hospitalization and showed a paulatine reduction in its size.
Once this treatment was instituted, the patient did not present heart failure, so that no valve replacement was required.
This associated therapy was maintained for six weeks.
The patient was clinically stable and was discharged without continuing antibiotic therapy.
A TTE showed vegetation healing two months later.
Follow-up did not detect relapse of the disease.
