Successful management of a complicated clinical crisis: A patient with left-sided endocarditis and secondary hemophagocytic lymphohistiocytosis: a rare case report and literature review.

Abstract:

RATIONALE:Hemophagocytic lymphohistiocytosis (HLH) secondary to methicillin-resistant Staphylococcus epidermidis (MRSE)-related left-sided infectious endocarditis had never been reported before. In the last decade, daptomycin, a novel lipopeptide antibiotic, showed its excellent role in anti-Gram-positive bacteria, including soft tissue infection, bloodstream and deep tissueinfection. PATIENT CONCERNS:An Asian women under sever condition due to the cooccurrence of HLH and MRSE-related endocarditis while also be allergic to vancomycin. The patient was cured by high-dose daptomycin monotheraphy, HLH-2004 protocol and cardiothoracic surgery to remove the valve at last, and was obviously benefit from the endeavor of a multidisciplinary team (MDT) strategy. DIAGNOSES:IE was made on March 27according to the modified Duke criteria. HLH was diagnosed too. INTERVENTIONS:The patient was cured by high-dose daptomycin monotheraphy, HLH-2004 protocol and cardiothoracic surgery to remove the valve at last, and was obviously benefit from the endeavor of a multidisciplinary team (MDT) strategy. OUTCOMES:The patient was healthy andstable when we published this case. LESSONS:This case proves high-dose daptomycin monotheraphy could be used as an effective alternative regimen for vancomycin in treating MRSE-related left-sided endocarditis and highlight the importance of early diagnosis and appropriate management for HLH. Furthermore, our work suggests an MDT model as a practical strategy in managing similar clinical situation.

journal_name

Medicine (Baltimore)

journal_title

Medicine

authors

Xu P,Zeng H,Zhou M,Ouyang J,Chen B,Zhang Q

doi

10.1097/MD.0000000000009451

subject

Has Abstract

pub_date

2017-12-01 00:00:00

pages

e9451

issue

51

eissn

0025-7974

issn

1536-5964

pii

00005792-201712220-00167

journal_volume

96

pub_type

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