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Case Reports
. 2022 Jan;63(1):103-109.
doi: 10.1007/s00108-021-01157-z. Epub 2021 Sep 29.

[Recurrent intracerebral haemorrhage in a 24-year-old female patient]

[Article in German]
S Hipp  1   2 , W von der Emde  3 , C Kulke  4 , M Schlotter  5 , J Schmidt  6 , J Kikhney  7   8 , A G M Hopf  7 , A Moter  7   8   9 , E Eszlari  10 , W Eichinger  10 , M Hinterseer  3   11
Affiliations
Case Reports

[Recurrent intracerebral haemorrhage in a 24-year-old female patient]

[Article in German]
S Hipp et al. Internist (Berl). 2022 Jan.

Abstract
in English, German

A 24-year-old female patient from Sierra Leone was referred to the authors' hospital after several unclear intracerebral bleeding events and an echogenic structure on the aortic valve. The patient was receiving oral anticoagulation therapy due to paroxysmal atrial fibrillation and left ventricular noncompaction. Fluorescence in situ hybridization in combination with polymerase chain reaction and sequencing revealed infective endocarditis of the mitral and aortic valve caused by Bartonella quintana. In retrospect, the intracerebral bleeding events could be identified as septic emboli with secondary haemorrhagic transformation under anticoagulation therapy. The patient showed significant clinical improvement and no further bleeding events occurred after receiving biological mitral and aortic valve replacement and several weeks of doxycycline and gentamicin antibiotic therapy.

Eine 24-jährige Patientin aus Sierra Leone wurde nach unklaren intrazerebralen Blutungsereignissen und einer echoreichen Auflagerung an der Aortenklappe vorstellig. Die Patientin war bei paroxysmalem Vorhofflimmern und Non-compaction-Kardiomyopathie antikoaguliert. In der weiteren Diagnostik gelang durch Fluoreszenz-in-situ-Hybridisierung in Kombination mit Polymerase-Kettenreaktion und Sequenzierung der Nachweis einer durch Bartonella quintana verursachten Mitral- und Aortenklappenendokarditis. Retrospektiv waren die intrazerebralen Hämorrhagien als septische Embolien mit sekundärer Einblutung unter neuen oralen Antikoagulanzien zu werten. Nach biologischem Mitral- und Aortenklappenersatz sowie mehrwöchiger Doxycyclin- und Gentamicingabe zeigte sich die Patientin in ihren Beschwerden deutlich gebessert und ohne weitere Blutungsereignisse.

Keywords: Bartonella quintana; In situ hybridization, fluorescence; Infective endocarditis; Left ventricular noncompaction; Trench fever.

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References

Literatur

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