单纯以发热为表现的亚急性感染性心内膜炎误诊分析及文献复习.pdfVIP

·42 · 临床误诊误治 ２０ 15 年 4 月 第 28 卷 第 4 期 Ｃｌｉｎｉｃａｌ Ｍｉｓｄｉａｇｎｏｓｉｓ ＆ Ｍｉｓｔｈｅｒａｐｙ熏 Ｖｏｌ．28熏 Ｎｏ．4熏 April ２０ 15 ·误诊误治与原因分析 · 单纯以发热为表现的亚急性感染性心内膜炎误诊分析及 文献复习 黎平祝,王越越,班　 雨,孟庆义 　 　 [摘要]　 目的　 探讨感染性心内膜炎(infectious endocarditis,IE)的临床特点、诊断及治疗方法,以降低误诊率。 方法　 对1例亚急性IE患者的临床资料进行回顾性分析,并复习相关文献。 结果　 本例为28岁女性,因反复低热2 月余入院,发病前1周有人工流产史。 曾于当地多家医院诊治,按发热原因待查、呼吸道感染等给予抗感染、退热对症 处理,症状无明显缓解。 收入院后完善各项医技检查亦无明显异常,予广谱抗生素治疗3d,发热仍反复;怀疑药物热, 停用抗生素2 d仍无效。 后经上级医师查房提醒再次复查心脏超声心动图提示心脏瓣膜有赘生物、瓣膜反流,心脏听 诊有杂音,血液细菌培养有溶血性链球菌生长,确诊为亚急性IE。 予替考拉宁治疗体温恢复正常,住院13 d病情好转 出院。 结论　 IE临床表现多样易误诊,临床医师对常规实验室、影像学检查无特异性发现的长期不明原因反复低热 患者应考虑本病可能,行心脏超声心动图检查重点观察瓣膜情况有助于本病确诊。 　 　 [关键词]　 原因不明发热;心内膜炎,细菌性;超声心动描记术;血液细菌培养;误诊;呼吸道感染 [中国图书资料分类号]　 R542.42　 　 　 [文献标志码]　 A　 　 　 　 [文章编号]　 1002-3429(2015)04-0042-04 [DOI]　 10.3969/ j.issn.1002-3429.2015.04.011 A Misdiagnosed Case of Subacute Infective Endocarditis Presented with Only Fever and the Literature Review 1 2 2 2 LI Ping-zhu ,WANG Yue-yue , BAN Yu , MENG Qing-yi (1. Emergency Department of Pingxiang Peoples Hospital, Pingxiang,Jiangxi337000,China;2. Emergency Department of General Hospital of PLA,Beijing 100853,China) [Abstract]　 Objective　 To explore the clinical characteristics,diagnosisandtreatment of infectiousendocarditis,and to reduce the misdiagnosisrate. Methods　 Clinicaldataof apatientwithsubacuteinfectiousendocarditisinourhospitalwere retrospectively analyzed and related literatureswere also reviewed. Results　 The 28-year-old female patient was admitted to hospital for prolonged low-gradefever for more than two months andwith the past history of artificial abortion about one week beforetheonset. Thepatienthadbeendiagnosedandreceivedtreatmentindifferentlocalhospitals. Shewasexaminedwithla- boratory and imaging testing in a local institution,but could not be definitively diagnosed. The patient received treatment of antibiotics and abatement of fever,but her symptomshadno mitigation. Upon admis