Successful surgical intervention for active infective endocarditis on a hemodialysis patient with cerebral infarction and disseminated intravascular coagulopathy

Abstract

A 48-year-old woman on hemodialysis developed congestive heart failure, neurologic deficits and disseminated intravascular coagulopathy (DIC) caused by methicillin resistant staphylococcus aureus infective endocarditis. Echocardiography showed large vegetation attached to the anterior leaflet of the mitral valve, severe mitral and aortic regurgitation, and poor left ventricular function. Computed tomography findings revealed recurrent embolic events including cerebral and splenic infarction, but no evidence of intracranial bleeding. Abnormal laboratory findings included DIC in addition to the administration of the daily dose of ticlopidine hydrochloride. Aortic and mitral valves were urgently replaced with bioprosthetic valves after the transfusion of fresh frozen plasma and platelet. During the follow-up period of one year, she was free from any cardiac events and infectious signs. Even though this report is limited to a case and its follow-up, it is sensible to conclude that only aggressive and timely surgical intervention can be the only lifesaving action for patients with highly infective endocarditis.