An unusual case report of mitral valve apparatus sparing left atrial appendage vegetation presenting as endogenous endophthalmitis
Tóm tắt
Ocular manifestations of infective endocarditis are nonspecific and rare. Endophthalmitis, retinal artery occlusion, Roth spots and vitreal and retinal infiltrations can all be seen with infective endocarditis. Also, infective endocarditis involving the left atrial appendage with no involvement of the mitral valve apparatus is a rarity. Here we report a case of infective endocarditis of the heart involving the left atrial appendage presenting with features of endogenous endophthalmitis which ultimately progressed to phthisis bulbi with subtle cardiac symptoms in a previous healthy young adult. Infective endocarditis involving the left chambers of the heart carries an inherent high risk of systemic embolization. Panophthalmitis which is considered to be the most severe form of endogenous endophthalmitis is a rare presenting feature. Although a definitive treatment algorithm is lacking, early surgery and parenteral antibiotics along with local antibiotic injections could help to save the vision.
Tài liệu tham khảo
Weis S, Piorkowski C, Arya A, Bollman A (2008) Septic vegetation at the left atrial appendage entrance after pulmonary vein ablation for atrial fibrillation. EP Europace 10:215–217
Habib G, Avierinos JF, Thuny F (2007) Aortic valve endocarditis: is there an optimal surgical timing? Curr Opin Cardiol 22:77–83
Habib G, Badano L, Tribouilloy C, Vilacosta I, Zamorano JL, Galderisi M et al (2010) Recommendations for the practice of echocardiography in infective endocarditis. Eur J Echocardiogr 11:202–219
Berdejo J, Shibayama K, Harada K, Tanaka J, Mihara H, Gurudevan et al. (2014) Evaluation of vegetation size and its relationship with embolism in infective endocarditis: a real-time 3-dimensional transesophageal echocardiography study. Circ Cardiovasc Imaging 7:149–154.
Thuny F, Beurtheret S, Mancini J, Gariboldi V, Casalta JP, Riberi A et al (2011) The timing of surgery influences mortality and morbidity in adults with severe complicated infective endocarditis: a propensity analysis. Eur Heart J 32:2027–2033
Wong JS, Chan TK, Lee HM, Chee SP (2000) Endogenous bacterial endophthalmitis: an east Asian experience and a reappraisal of a severe ocular affliction. Ophthalmology 107:1483–1491