Key result
Broad-spectrum antibiotics fail to prevent fatal coronary sinus endocarditis in a hemodialysis patient.
Why the study?
Coronary sinus vegetation can be fatal in hemodialysis patients with impaired immune systems, especially when diagnosis is delayed.
Case Report (n=1)
Coronary sinus vegetation can be a fatal complication in hemodialysis patients, highlighting the importance of echocardiography in evaluating undifferentiated shock.
May prove fatal in hemodialysis patients despite antibiotics; hypothesis-generating for echocardiography in undifferentiated shock.
BACKGROUND: echocardiography in a hemodialysis patient with undifferentiated shock. The CS vegetation may have been caused by endocardial denudation due to tricuspid regurgitant jet and subsequent bacteremia. CASE SUMMARY: A 91-year-old man with dyspnea and hypotension was transferred from a nursing hospital. He was on regular hemodialysis and had a history of severe grade of tricuspid regurgitation. There was no leukocytosis or fever upon admission. Repetitive and sequential blood cultures revealed absence of microorganism growth. Chest computed tomography showed lung consolidation and a large pleural effusion. A mobile band-like mass on the CS, suggestive of vegetation, was observed on echocardiography. We diagnosed him with infective endocarditis involving the CS, pneumonia, and septic shock based on echocardiographic, radiographic, and clinical findings. Infusion of broad-spectrum antibiotics, fluid resuscitation, inotropic support, and ventilator care were performed. However, the patient died from uncontrolled infection and septic shock. CONCLUSION: CS vegetation can be fatal in hemodialysis patients with impaired immune systems, especially when it delays the diagnosis.
No takes yet. Share an insight, caveat, or question.
Hwang et al. (2021) conducted a case report in Coronary sinus endocarditis (n=1). Broad-spectrum antibiotics and supportive care was evaluated on Clinical outcome (death). A 91-year-old hemodialysis patient with coronary sinus endocarditis died from uncontrolled infection and septic shock despite broad-spectrum antibiotics and supportive care.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: