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07. Syncope and Bradycardia
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31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
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34. Public Health and Health Economics
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An unusual case of Haemophilus parainfluenzae pancarditis
Session:
Casos Clínicos: Doença Valvular, Pericárdica, Pulmonar, Congénita e Miocardiopatias
Speaker:
Sofia Nogueira Fernandes
Congress:
CPC 2024
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
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Subtheme:
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Session Type:
Sessão de Casos Clínicos
FP Number:
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Authors:
Sofia Nogueira Fernandes; Jorge Marques; Sérgia Rocha; Alexandre Carvalho; Silvia Ribeiro; Nuno Salomé; Vitor Hugo Pereira; Cátia Oliveira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="font-size:12.0pt">A previously healthy 42-year-old female patient, presented with a 6-day history of fever, asthenia and chest pain that worsened with inspiration and when laying down. Notably, s<span style="background-color:white"><span style="color:black">he had a history of </span></span>dental extraction a month before the beginning of the symptoms. She had no history of recent airway or gastrointestinal infections. <span style="background-color:white"><span style="color:black">On physical examination she had systolic murmur grade II/VI, </span></span>without signs of congestive heart failure.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="font-size:12.0pt">Her ECG revealed sinus rhythm and right bundle branch block. <span style="background-color:white"><span style="color:black">Her bloodwork revealed mild anaemia (Haemoglobin 10,1 g/dl), elevated troponin I (2,476 µg/mL), and elevated C reactive protein (149 mg/L). </span></span>Haemocultures came back positive for <em>Haemophilus parainfluenzae</em>. <span style="background-color:white"><span style="color:black">A transthoracic </span></span>echocardiogram showed a mass of small dimensions in the posterior leaflet of the mitral valve, suggestive of vegetation, with mild to moderate mitral insufficiency, minimal circumferential pericardial effusion and hypokinesia of the middle and apical segments of the posterior wall of the left ventricle. The transoesophageal echocardiogram confirmed a vegetation measuring approximately 12 x 3 millimetres in the posteromedial commissure of the mitral valve, with perforation of the leaflet, causing moderate mitral insufficiency. A cardiac magnetic resonance revealed foci of fibrosis of non-ischemic pattern compatible with clinical suspicion of myocarditis. </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="font-size:12.0pt">Targeted antibiotic therapy with ciprofloxacin was maintained for 4 weeks, associated with anti-inflammatory therapy</span><span style="font-size:12.0pt">,</span> <span style="font-size:12.0pt">mainly aimed to symptomatic relief</span><span style="font-size:12.0pt">. </span><span style="font-size:12.0pt">Control haemocultures were negative and the patient maintained clinical stability throughout hospitalisation.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="font-size:12.0pt"><span style="background-color:white"><span style="color:black">This is a rare c</span></span></span><span style="font-size:12.0pt">ase of native valve infective endocarditis caused by Haemophilus parainfluenzae with concomitant myopericarditis. </span></span></span></p> <p style="text-align:justify"> </p>
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