Case Study FollowUp

Laboratory data revealed leukocytosis, normal hematocrit, and mildly elevated liver enzymes. Urinalysis showed 6-10 RBCs per high-power field and no active urinary sediment. Three of six blood cultures grew Gram-positive cocci. The organism was difficult to identify and the culture was referred to the Federal Reference Laboratory for characterization.

The chest x-ray was normal. The electrocardiogram revealed sinus rhythm with a normal PR interval. A CT scan of the abdomen revealed splenic infarcts and possible renal infarcts. TTE revealed mechanical aortic valve stenosis a mean aortic systolic gradient was 46 mm Hg and the calculated valve area was 0.9 cm2. The left ventricular ejection fraction was normal at 67%. A large mass was suspected on the mechanical aortic valve and was confirmed by TEE, which revealed a mobile mass measuring 4 x 5 mm consistent with a vegetation. There was no evidence of perianular abscess formation.

The patient was treated with vancomycin for six weeks and gentamicin for two weeks. A cardiac surgical consultant recommended completion of antiobiotic therapy and subsequent replacement of the aortic valve prosthesis.

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