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A massive haemothorax as an unusual complication of infective endocarditis caused by Streptococcus sanguinis

Authors
Kim, Kyoung JinLee, Kang WonChoi, Ju HeeSohn, Jang WookKim, Min JaYoon, Young Kyung
Issue Date
Aug-2016
Publisher
TAYLOR & FRANCIS LTD
Keywords
Streptococcus sanguinis; Infective endocarditis; Pulmonary embolism; Haemothorax
Citation
ACTA CLINICA BELGICA, v.71, no.4, pp.253 - 257
Indexed
SCIE
Journal Title
ACTA CLINICA BELGICA
Volume
71
Number
4
Start Page
253
End Page
257
URI
https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/6238
DOI
10.1080/17843286.2015.1105608
ISSN
1784-3286
Abstract
Objective and importance: Infective endocarditis involving the tricuspid valve is an uncommon condition, and a consequent haemothorax associated with pulmonary embolism is extremely rare. Particularly, there are no guidelines for the management of this complication. We describe a rare case of pulmonary embolism and infarction followed by a haemothorax due to infective endocarditis of the tricuspid valve caused by Streptococcus sanguinis.Clinical presentation: A 25-year-old man with a ventricular septal defect (VSD) presented with fever. On physical examination, his body temperature was 38.8 degrees C, and a grade III holosystolic murmur was heard. A chest X-ray did not reveal any specific findings. A transoesophageal echocardiogram showed a perimembranous VSD and echogenic material attached to the tricuspid valve. All blood samples drawn from three different sites yielded growth of pan-susceptible S. sanguinis in culture bottles. On day 12 of hospitalization, the patient complained of pleuritic chest pain without fever. Physical examination revealed reduced breathing sounds and dullness in the lower left thorax. On his chest computed tomography scan, pleural effusion with focal infarction and pulmonary embolism were noted on the left lower lung. Thoracentesis indicated the presence of a haemothorax.Intervention: Our case was successfully treated using antibiotic therapy alone with adjunctive chest tube insertion, rather than with anticoagulation therapy for pulmonary embolism or cardiac surgery.Conclusion: When treating infective endocarditis caused by S. sanguinis, clinicians should include haemothorax in the differential diagnosis of patients complaining of sudden chest pain.
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Kim, Min Ja
Anam Hospital (Department of Infectious Diseases, Anam Hospital)
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