Volume 14, Issue 4 ( December 2022 2022)                   Iranian Journal of Blood and Cancer 2022, 14(4): 111-115 | Back to browse issues page

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Kusumawardhani N, Dewi I P, Wardhani L F K, Budiarto M. Blood culture-negative infective endocarditis with thalassemia and neurological complication: A dangerous combination. Iranian Journal of Blood and Cancer 2022; 14 (4) :111-115
URL: http://ijbc.ir/article-1-1258-en.html
Blood culture-negative infective endocarditis with thalassemia and neurological complication: A dangerous combination
Novia Kusumawardhani1 , Ivana Purnama Dewi * 2, Louisa Fadjri Kusuma Wardhani1 , Mohammad Budiarto1
1- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Airlangga University – dr. Soetomo General Hospital, Surabaya, Indonesia
2- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Airlangga University – dr. Soetomo General Hospital, Surabaya, Indonesia 2Faculty of Medicine Duta Wacana Christian University, Yogyakarta, Indonesia , 916ivana@gmail.com
Abstract:   (533 Views)
Background: Infective endocarditis (IE) is a life-threatening systemic disease that mostly affects people with valvular heart disease, prosthetic valves, or intracardiac devices. Infective endocarditis is a dangerous cardiac involvement in thalassemia patients. Thus, a multidisciplinary approach is important to provide efficient and effective therapy.
Case presentation: A 31-year-old man came to our tertiary referral hospital complaining of right-side paralysis of the body and slurred speech. Vital signs were normal. There were grade III/VI systolic murmurs from chest examination in midclavicular line intercostal space V sinistra. Head CT scan without contrast showed an embolic event. Peripheral blood smear showed iron deficiency anemia. Further electrophoresis hemoglobin (Hb) examination showed HbE-pathy. Echocardiography showed vegetations on the anterior and posterior mitral leaflet, leading to severe mitral regurgitation (MR). Blood culture examinations showed no bacterial growth. The patient was then diagnosed with severe MR due to possible IE, acute stroke infarction, and HbE thalassemia. The patient was treated with optimal medical therapy because he refused surgery. After six months of follow up, patients were found dead at his house
Conclusions: Thalassemia is a risk factor for infective endocarditis. Both are a dangerous combination, and early recognition should be made carefully to prevent worse outcome.
Keywords: Infective endocarditis, Negative Blood culture, Thalassemia, Stroke
Full-Text [PDF 1210 kb]   (414 Downloads)    
: Case report | Subject: Infectious Diseases
Received: 2022/05/22 | Accepted: 2022/12/2 | Published: 2022/12/28
References
1. Guillermo Martinez KVF. Infective Endocarditis. Continuing Education in Anaesthesia, Critical Care & Pain. 2012; 12(3). [DOI:10.1093/bjaceaccp/mks005]
2. Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Zotti FD, et al. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J. 2015; 36(44): 3075-3128. [DOI:10.1093/eurheartj/ehv319]
3. Murai R, Funakoshi S, Kaji S, Kitai T, Kim K, Koyama T, et al. Outcomes of early surgery for infective endocarditis with moderate cerebral complications. J Thorac Cardiovasc Surg. 2017; 153(4): 831-840 e8. [DOI:10.1016/j.jtcvs.2016.10.074]
4. Botta L, Savini C, Martin-Suarez S, Dell'Amore A, Camurri N, Arpesella G, et al., Successful mitral valve replacement in a patient with a severe form of beta-thalassaemia. Heart Lung Circ. 2008; 17(1): 77-9. [DOI:10.1016/j.hlc.2006.09.010]
5. Galanello R and Origa R. Beta-thalassemia. Orphanet J Rare Dis. 2010; 5: 11. [DOI:10.1186/1750-1172-5-11]
6. Aessopos A, Farmakis D, Karagiorga M, Voskaridou E, Loutradi A, Hatziliami A, et al. Cardiac involvement in thalassemia intermedia: a multicenter study. Blood. 2001; 97(11): 3411-6. [DOI:10.1182/blood.V97.11.3411]
7. Raffa GM, Mularoni A, Di Gesaro G, Vizzini G, Cipolla T, Pilato M. Thalassemia and heart surgery: aortic valve repair after endocarditis. Ann Thorac Surg. 2015; 99(1): e1-2. [DOI:10.1016/j.athoracsur.2014.09.083]
8. Omoto T, Tedoriya T, Kondo Y, Izuka H, Oi M, Nagano N, et al. Aortic valve replacement in a patient with alpha-thalassemia. Ann Thorac Cardiovasc Surg. 2010; 16(5): 365-6.
9. Darwazah AK, Helwa K, Sharabati B. Acute mitral valve endocarditis complicated by right atrial fistula in beta-thalassemia major. J Heart Valve Disease. 2010; 19 (4): 434-437.
10. Farmakis D, Polonifi A, Deftereos S, Tsironi M, Papaioannou I, Aessoposa A, et al. Aortic valve replacement in a patient with thalassemia intermedia. Ann Thorac Surg. 2006; 81(2): 737-9. [DOI:10.1016/j.athoracsur.2004.12.003]
11. Métras D, Coulibaly AO, Ouattara K, Longechaud A, Millet P, Chauvet J. Open-heart surgery in sickle-cell haemoglobinopathies: report of 15 cases. Thorax. 1982; 37(7): 486-91. [DOI:10.1136/thx.37.7.486]
12. deLeval MR, Taswell HF, Bowie EJ, Danielson GK. Open heart surgery in patients with inherited hemoglobinopathies, red cell dyscrasias, and coagulopathies. Arch Surg. 1974; 109(5): 618-22. [DOI:10.1001/archsurg.1974.01360050016005]
13. Eldor A and Rachmilewitz EA. The hypercoagulable state in thalassemia. Blood. 2002; 99(1): 36-43. [DOI:10.1182/blood.V99.1.36]
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