A Case of Infective Endocarditis Caused by Odontogenic Maxillary Sinusitis in an Older Patient with Dementia

Abstract

　Older adults with dementia may have difficulty in visiting a dentist due to physical symptoms, behavioral and psychological symptoms of dementia（BPSD）, and the environment of care. In this study, we report a case of infective endocarditis caused by apical periodontitis with odontogenic maxillary sinusitis in an older patient with dementia. The patient, a 97-year-old woman, had Alzheimerʼs disease. She presented to our emergency room with a chief complaint of fever and was admitted as an emergency case of bacteremia. Blood culture revealed Streptococcus anginosus, an oral streptococcus, and transesophageal echocardiography showed a verrucoma on the mitral valve, leading to the diagnosis of infective endocarditis（IE）. She was referred to our department for further investigation of the source of IE. On CT imaging, the left maxillary first molar showed odontogenic maxillary sinusitis with root apical periodontitis spreading to the left maxillary sinus, which was revealed to be the source of the infective endocarditis. Because of her strong refusal of treatment, we extracted the causative tooth, a left maxillary first molar, and other remaining roots under psychosedation. In order to continue dental therapy and perform oral hygiene after discharge from the hospital, we arranged for a home dental visit during the hospitalization and instructed the caregiver on oral care. After administration of penicillin G, her fever quickly resolved, and blood culture tests were negative. However, mitral regurgitation worsened due to mitral valve destruction, and heart failure progressed, resulting in death on the 31st day after first visiting our hospital.