Paraparesis: A Rare Presentation of Infectious Endocarditis Caused by Streptococcus Bovis

不尋常臨床表現：牛型鏈球菌心內膜炎造成之下半身輕癱

林東煜(Tang-Yu Lin) ； 陳國泰(Kuo-Tai Chen) ； 林宏榮(Hung-Jung Lin) ； 湯宏仁(Hung-Jen Tang)

《中華民國急救加護醫學會雜誌》 15卷4期 (2004/12) Pp. 169-174

https://doi.org/10.30018/JECCM.200412.0006

摘要

本文描述一位51歲男性因漸進式下半身輕癱至急診就診，初始之臆斷為感染性肌炎或脊椎之硬膜外膿瘍，但最終之診斷爲牛型鏈球菌心內膜炎合併主動脈及雙側髂動脈栓塞。牛型鏈球是常見的感染性心內膜炎菌種，且常與大腸之惡性腫瘤有關。回顧文獻未曾有牛型鏈球菌心內膜炎造成下半身輕癱之報告。這位病人以主動脈瓣置換，雙側主動脈髂分流及靜注抗生素成功治癒。經六個月的追蹤，並未發現手術之併發症或反覆之瓣膜感染。

關鍵字

牛型鏈球菌 ； 感染性心內膜炎 ； 下身輕癱

並列摘要

We present a 51 year-old man who visited the emergency department due to intermittent claudication, prolonged fever, chills and gradual onset of paraparesis. The initial differential diagnosis included infective myositis and spinal epidural abscess. However, the final diagnosis was endocarditis caused by streptococcus bovis infection with aortic and bilateral iliac artery embolism. Streptococcus bovis is a well-documented pathogen of infective enocarditis and is usually connected with malignancy of the colon. It occurs in 11 to 19% of cases of infective endocarditis, but there are few, if any, cases of streptococcus bovis infective endocarditis with paraparesis as the initial presentation in the literature. The patient was treated successfully with aortic valve replacement, bilateral aorto-iliac bypass and intravenous antibiotics. After six months follow-up, there were no surgical complications or recurrent valve infection.

並列關鍵字

paraparesis ； Streptococcus bovis ； endocarditis