2018 Volume 15 Issue 1 Pages 105-109
Abstract：A 59-year-old male was transferred to our institution for the treatment of refractory heart failure accompanied by severe systemic inflammation, who had been diagnosed renal impairment due to Henoch-Schönlein purpura 5 months before. Echocardiography revealed severe aortic regurgitation and moderate-severe mitral regurgitation caused by infective endocarditis. His refractory heart failure progressively deteriorated renal function, and thus, urgent aortic and mitral valve replacements were performed using 25mm and 29mm of mechanical prostheses, respectively. Causative organism was not determined during the whole clinical course, and it was decided not to use gentamicin sulfate in consideration of progressive renal dysfunction. His renal histological findings had been characteristic of proliferative glomerulonephritis with granular mesangial immunoglobulin-A deposition, and thus, polyethyleneglycol-treated human immunoglobulin containing the lowest level of Immunoglobulin-A was used in combination with intravenous ampicillin/sulbactam for the initial postoperative anti-inflammatory empiric treatment. Refractory systemic inflammation was immediately ameliorated without irreversible renal dysfunction, and the patient was discharged on the 33rd postoperative day. No signs of recurrent endocarditis were observed during 7 years of follow-up.
