1992 Volume 3 Issue 1 Pages 8-11
A 62-year-old woman who had undergone a hemodialysis for chronic renal failure was admitted for unconciousness. A brain CT showed left cerebral infarction. On her 8th hospital day, she suddenly developed a progressive congestive heart failure. An echocardiogram revealed an aortic valve vegetation and blood culture grew methicillin-resistant Staphylococcus aureus (MRSA), confirming the diagnosis of Infective endocarditis. On the 15th day, the patient died of acute heart failure. At autopsy the aortic valve showed a perforation 0.8cm in diameter. It is difficult to treat endocarditis in patients on chronic hemodialysis since such patients have altered host defenses and suppressed immune systems. Vascular access sites are the common source of infections leading to endocarditis and sepsis. Hemodialyzed patients with endocarditis generally fail to respond to medical therapy alone. Once congestive heart failure has occurred due to perforation of a valve leaflet, prompt cardiac valve replacement should be performed at an early stage.
