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(Circulation. 2008;118:684-686.)
© 2008 American Heart Association, Inc.

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Rupture of Infected Splenic Artery Aneurysm Secondary to Infective Endocarditis

Tsutomu Araki, MD; Kunihiro Ogane, MD

From the Department of Internal Medicine, Saiseikai Kanazawa Hospital, Kanazawa, Japan.

Reprint requests to Tsutomu Araki, MD, Department of Internal Medicine, Saiseikai Kanazawa Hospital, Ni 13–6, Akatsuchi-machi, Kanazawa 920–0353, Japan. E-mail saiseikh@kma.jp

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Infected splenic artery aneurysm is a rare but, if ruptured, serious complication of infective endocarditis.¹ We report the case of an individual with infective endocarditis who suddenly died during the antibiotic therapy. A 48-year-old man was admitted with a 2-month history of slight fever, general malaise, leg edema, and decreased urine output. He had no history of heart disease, tooth extraction, or drug addiction. On physical examination, a grade-3 systolic murmur was heard at the cardiac apex and marked edema was noted in the lower legs. Laboratory tests showed a white blood cell count of 21 800/mm³ (90% of which were neutrophils), serum C-reactive protein of 17.6 mg/dL, blood urea nitrogen of 51.5 mg/dL, serum creatinine of 7.37 mg/dL, and marked proteinuria and hematuria. Blood cultures obtained on admission were positive for hemolytic streptococcus. Electrocardiography showed no abnormal findings, except for sinus tachycardia (Figure 1). Transthoracic and transesophageal echocardiography revealed a seaweed-like vegetation attached to the mitral valve ring (Figure 2) and severe mitral regurgitation. Abdominal computed tomography revealed enlarged bilateral kidneys and no abnormal findings in the spleen and splenic artery (Figure 3). On the basis of these findings, infective endocarditis complicated with renal failure was diagnosed, and intensive antibiotic therapy with sultamicillin and meropenem was started. Because the serum creatinine level increased to 9.17 mg/dL on the fourth hospital day, the short-term corticosteroid therapy (intravenous methylprednisolone 0.5g per day for 3 days, then oral prednisolone 30 mg, 20 mg, and 10 mg . . . [Full Text of this Article]