European Heart Journal Advance Access published December 10, 2014
CARDIOVASCULAR FLASHLIGHT
doi:10.1093/eurheartj/ehu471
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Infective endarteritis associated with aortic dissection underlying bacterial meningitis Yasuhide Mochizuki1, Hidekazu Tanaka1*, Yukiko Morinaga2, Yutaka Okita3, and Ken-ichi Hirata1 1 Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan; 2Division of Pathology, Department of Pathology, Kobe University Graduate School of Medicine, Kobe, Japan; and 3Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
* Corresponding author. Tel: +81 78 382 5846, Fax: +81 78 382 5859, Email: [email protected]
Supplementary material is available at European Heart Journal online. Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2014. For permissions please email: [email protected].
Downloaded from by guest on January 9, 2015
A 74-year-old male without a history of immunological disorders was transferred to our hospital for further evaluation of persistent high fever in spite of having received optimal antibiotics administration for 13 days. He was diagnosed with bacterial meningitis, and streptococcus agalactiae was identified by the findings of both cerebrospinal fluid culture and blood culture studies at the local hospital. A contrast computed tomography scan revealed DeBakey type IIIb aortic dissection (Panel A). Transesophageal echocardiography showed a markedly thickened flap with aggregated and cord-like vegetation on the inside of the intima at the entry site of aortic dissection (Panels B and C, Supplementary material online, Videos S1 and S2). No evidence of endocarditis involving either heart valve or any congenital heart disease was observed. This information, together with the patient’s clinical features suggested a diagnosis of infective endarteritis associated with aortic dissection underlying bacterial meningitis. Two days after the diagnosis, the patient successfully underwent surgical treatment with graft replacement of the descending aorta, followed by complete elimination of fever. The histological finding of Elastica– Goldner staining at the entry site of the aortic dissection showed vegetation into a tear between intima and media (Panel D), while the finding of hematoxylin-eosin staining obtained from tissue of the vegetation was indicative of the migration of neutrophil cells and basophilic necrotic matter including nuclear dust (Panel E). The bacterial agent itself was not proven from the excised samples such as the aorta, and the culture of aortic specimens was negative. The atherosclerotic lesion was also found at the site of tear. To the best of our knowledge, this is the first case report of an elderly patient without congenital heart disease diagnosed with infective endarteritis associated with aortic dissection underlying bacterial meningitis on the basis of microscopic proof of bacterial infection.
CARDIOVASCULAR FLASHLIGHT
doi:10.1093/eurheartj/ehu471
.............................................................................................................................................................................
Infective endarteritis associated with aortic dissection underlying bacterial meningitis Yasuhide Mochizuki1, Hidekazu Tanaka1*, Yukiko Morinaga2, Yutaka Okita3, and Ken-ichi Hirata1 1 Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan; 2Division of Pathology, Department of Pathology, Kobe University Graduate School of Medicine, Kobe, Japan; and 3Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
* Corresponding author. Tel: +81 78 382 5846, Fax: +81 78 382 5859, Email: [email protected]
Supplementary material is available at European Heart Journal online. Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2014. For permissions please email: [email protected].
Downloaded from by guest on January 9, 2015
A 74-year-old male without a history of immunological disorders was transferred to our hospital for further evaluation of persistent high fever in spite of having received optimal antibiotics administration for 13 days. He was diagnosed with bacterial meningitis, and streptococcus agalactiae was identified by the findings of both cerebrospinal fluid culture and blood culture studies at the local hospital. A contrast computed tomography scan revealed DeBakey type IIIb aortic dissection (Panel A). Transesophageal echocardiography showed a markedly thickened flap with aggregated and cord-like vegetation on the inside of the intima at the entry site of aortic dissection (Panels B and C, Supplementary material online, Videos S1 and S2). No evidence of endocarditis involving either heart valve or any congenital heart disease was observed. This information, together with the patient’s clinical features suggested a diagnosis of infective endarteritis associated with aortic dissection underlying bacterial meningitis. Two days after the diagnosis, the patient successfully underwent surgical treatment with graft replacement of the descending aorta, followed by complete elimination of fever. The histological finding of Elastica– Goldner staining at the entry site of the aortic dissection showed vegetation into a tear between intima and media (Panel D), while the finding of hematoxylin-eosin staining obtained from tissue of the vegetation was indicative of the migration of neutrophil cells and basophilic necrotic matter including nuclear dust (Panel E). The bacterial agent itself was not proven from the excised samples such as the aorta, and the culture of aortic specimens was negative. The atherosclerotic lesion was also found at the site of tear. To the best of our knowledge, this is the first case report of an elderly patient without congenital heart disease diagnosed with infective endarteritis associated with aortic dissection underlying bacterial meningitis on the basis of microscopic proof of bacterial infection.
