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KMID : 0614720010440111225
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Journal of Korean Medical Association
2001 Volume.44 No. 11 p.1225 ~ p.1231
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Subacute Bacterial Endocarditis and Cerebral mycotic Aneurysm
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Abstract
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A 30-year-old man was transferred to Yonsei Cardiovascular Hospital after 20 days of hospitalization under the diagnosis of bacterial endocarditis with mitral regurgitation and septic splenic infarct. He had suffered from intermittent high fever
and
general weakness for 3 months. Echocardiogram showed moderate mitral regurgitation and multiple large vegetations in both leaflets. Streptococcus viridans was confirmed by blood cultures, and administration of cefazoline and gentamycin was
initiated.
During the antibiotic therapy, abdominal and left calf pain developed, and abdominal computed tomography showed splenic and right renal infarct. He also complained intermittent headache and visual distrubance. Brain computed tomography and four
vessels
angiography showed a small aneurysm in right hemisphere and other small aneurysm in fronto-occipital area of left middle cerebral artery. No more systemic embolization developed until the completion of six weeks of antibiotic therapy. The patient
underwent mitral valve replacement with #29 Carpenitier-Edwards Bioprosthesis. At operation, the anterior and posterior mitral leaflets were found perforated and covered with leaflets were found perforated and covered with multiple vegetations.
Follow-up cerebral angiography taken at seventh postoperative day, showed enlargement of cerebral aneurysm. Clipping of saccular aneurysms on left M3 and M4 were performed and complete resolution of aneurysm was confirmed by brain computed
tomography.
On operative finding, an aneurysm was found on with saccular type. The patient was dischanged without complication on eighth postoperative day.
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