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Review
. 2017 Dec;96(51):e9451.
doi: 10.1097/MD.0000000000009451.

Successful management of a complicated clinical crisis: A patient with left-sided endocarditis and secondary hemophagocytic lymphohistiocytosis: a rare case report and literature review

Peipei Xu  1 , Hui Zeng, Min Zhou, Jian Ouyang, Bing Chen, Qiguo Zhang
Affiliations
Review

Successful management of a complicated clinical crisis: A patient with left-sided endocarditis and secondary hemophagocytic lymphohistiocytosis: a rare case report and literature review

Peipei Xu et al. Medicine (Baltimore). 2017 Dec.

Abstract

Rationale: Hemophagocytic lymphohistiocytosis (HLH) secondary to methicillin-resistant Staphylococcus epidermidis (MRSE)-related left-sided infectious endocarditis had never been reported before. In the last decade, daptomycin, a novel lipopeptide antibiotic, showed its excellent role in anti-Gram-positive bacteria, including soft tissue infection, bloodstream and deep tissueinfection.

Patient concerns: An Asian women under sever condition due to the cooccurrence of HLH and MRSE-related endocarditis while also be allergic to vancomycin. The patient was cured by high-dose daptomycin monotheraphy, HLH-2004 protocol and cardiothoracic surgery to remove the valve at last, and was obviously benefit from the endeavor of a multidisciplinary team (MDT) strategy.

Diagnoses: IE was made on March 27according to the modified Duke criteria. HLH was diagnosed too.

Interventions: The patient was cured by high-dose daptomycin monotheraphy, HLH-2004 protocol and cardiothoracic surgery to remove the valve at last, and was obviously benefit from the endeavor of a multidisciplinary team (MDT) strategy.

Outcomes: The patient was healthy andstable when we published this case.

Lessons: This case proves high-dose daptomycin monotheraphy could be used as an effective alternative regimen for vancomycin in treating MRSE-related left-sided endocarditis and highlight the importance of early diagnosis and appropriate management for HLH. Furthermore, our work suggests an MDT model as a practical strategy in managing similar clinical situation.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
PET-CT on March 27, 2015. (A, B, and D) Splenomegaly and a relatively increased SUV (maximum at 3.3) of the spleen,compared with the liver, was observed. (C and D) No mass or sign of metastasis was observed in the abdominal cavity. The 3 arrows in (A, B, and D) all point at the enlarged spleen.
Figure 2
Figure 2
Echocardiography images during hospitalization. (A and B) Echocardiography images obtained on April 10, 2015 and May 7, 2015, where arrow point at revealed a well-shaped vegetation attached to the aortic valve. (C and D) The images obtained on June 4, 2015, 1 week after surgery, and September 08, showed no left-to-right atrial shunt after surgery.
Figure 3
Figure 3
Shows how the patient's temperature responded to antibiotics during the treatment course and the different results of the culture with time. Note: the red stars indicate that bacterial colonies of methicillin-resistant Staphylococcus epidermidis were observed in the blood or bone marrow samples, and the green star indicates that no living microbes were detected in the blood sample.
See this image and copyright information in PMC

References

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