以反复颅内出血为特征的亚急性感染性心内膜炎二例临床分析

Clinical analysis of two subacute infective endocarditis characterized by recurrent intracranial hemorrhage

目的通过分析二例以反复颅内出血为特征的亚急性感染性心内膜炎的临床特点,提高对该病的认识和诊断水平。方法对二例在我院住院的亚急性感染性心内膜炎患者的临床表现、既往病史、实验室检查、及心脏B超进行分析。结果此两例患者均为青年起病,以反复颅内出血为主要症状,查体可闻及心尖部杂音,既往均曾有不典型发热、皮下结节及关节疼痛等表现,心脏B超见心脏赘生物及血培养见草绿色链球菌均支持感染性心内膜炎的诊断。结论感染性心内膜炎的临床表现错综复杂,症状隐匿,以反复颅内出血为主要症状的病例为少见,加上临床医师对此病认识不足,诊断思路狭窄,造成本病误诊漏诊率高。

Objective The clinical features of two IE characterized by recurrent intracranial hemorrhage were analyzed in order to improve diagnosis. Method The clinical manifestations, past history, laboratory examination and UCG of two in hospital IE patients were retrospectively reviewed. Result In both cases, the onsets of intracranial hemorrhage were at an early age and repeated. Pathologic cardiac murmur could be heard at the cardiac apex in the patients. In the past history both had typical fever, Osier nodules and joint pain as. signs of IE. Cardiac vegetations were found by UCG and Viridans streptococci in blood cultivation supported the diagnosis. Conclusion It is rather rare to see SIE characterized by recurrent intracranial hemorrhage. The complicated clinical manifestations and concealed symptoms of IE in addition with inadequate knowledge of this disease and narrow thinking of clinicians may lead to missed or inaccurate diagnosis.