表现为间断发热的感染性心内膜炎误诊剖析

Analysis of Misdiagnosis of Infective Endocarditis with Intermittent Fever as Primary Manifestation

目的分析以间断发热为主要表现的感染性心内膜炎的临床特点及误诊原因。方法对我院收治的1例感染性心内膜炎的临床资料进行回顾性分析。结果本例因间断发热1年,病情复发6 d入院。曾误诊为上呼吸道感染、淋巴瘤、结缔组织病,予对症处理后仍反复发作。入院后血培养提示溶血性链球菌;经食管心脏彩色多普勒超声(彩超)检查示:二尖瓣脱垂伴中量反流,二尖瓣赘生物形成。诊断为感染性心内膜炎,予抗感染并二尖瓣、三尖瓣置换术,后病情平稳出院。随访半年,患者无发热,精神、食欲可。结论以间断发热为主要表现的感染性心内膜炎早期可无心脏彩超异常表现,临床需仔细鉴别诊断,减少误诊误治。

Objective To analyze the clinical characteristics and causes of misdiagnosis of infective endocarditis（IE） with intermittent fever as primary manifestation. Methods The clinical data of one patient with IE who was treated in our hospital were retrospectively analyzed. Results A 66-year-old male patient with intermittent fever for 1 year was hospitalized for recurrence of fever for 6 days. The patient had been initially diagnosed as having upper respiratory tract infection,lymphoma,or connective tissue disease. However,the patient had recurrent fever after symptomatic treatment. After admission to our hospital,blood culture showed hemolytic streptococcus. The transesophageal echocardiography（color Doppler ultrasound） revealed mitral valve prolapse,moderate mitral regurgitation,and formation of mitral valve vegetations. The patient was diagnosed with IE,which was treated with mitral and tricuspid valve replacement after anti-infection treatment. The patient was discharged home at stable condition.During the six months of follow-up,the patient was in good spirit and had appetite without fever. Conclusion IE patients with intermittent fever as primary manifestation can be normal in the early stage by echocardiography,which requires careful differential diagnosis,thereby reducing misdiagnosis and mistreatment.