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- W2810361057 abstract "A 37-year-old man receiving haemodialysis for chronic renal failure presented with chest pain, dyspnoea, and fever. Ceftriaxone and spiramycin were initiated based on the presumption of community-acquired pneumonia. This was rapidly switched to cefazolin, clindamycin, and gentamicin, as blood cultures yielded methicillin-susceptible Staphylococcus aureus and a transthoracic echocardiogram highlighted a 6-mm mitral vegetation indicative of infective endocarditis (IE). A computed tomography (CT) scan revealed a peripheral pulmonary artery aneurysm within a condensation of the right lower lobe (Figure 1A) necessitating coil embolization. Cerebral T2*-weighted magnetic resonance imaging (MRI) displayed multiple micro-bleeds (Figure 1B). The patient’s clinical condition promptly improved and blood cultures turned negative within 4 days. Six weeks later, a transthoracic echocardiogram revealed a 4-cm mass next to the tricuspid valve (Figure 2A) without residual vegetation or valvular insufficiency. A CT scan disclosed a right coronary artery aneurysm (Figure 2B), confirmed by angiography (Figure 2C), requiring an emergency surgical flattening.Figure 2Six-week follow-up disclosing a voluminous mass next to the tricuspid valve on transthoracic echocardiography (A, arrow); a CT scan (B) and angiography (C) revealed a 4-cm right coronary aneurysm (circled) that was partly thrombosed.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Coronary mycotic aneurysms are rare complications of IE (Herzog et al., 1991Herzog C.A. Henry T.D. Zimmer S.D. Bacterial endocarditis presenting as acute myocardial infarction: a cautionary note for the era of reperfusion.Am J Med. 1991; 90: 392-397Abstract Full Text PDF Scopus (56) Google Scholar, Shariff et al., 2009Shariff N. Combs W. Roberts J. Large mycotic pseudoaneurysm of the left circumflex treated with antibiotics and covered stent.J Invasive Cardiol. 2009; 21: E37-8Google Scholar, Tizon-Marcos et al., 2010Tizon-Marcos H. Bagur R. Bilodeau S. Larose E. Dagenais F. Dery J.P. Left main mycotic aneurysm causing myocardial infarction.Can J Cardiol. 2010; 26: e276-e277Google Scholar, Westover and Benedick, 2007Westover K. Benedick B. Mycotic aneurysm of the left main coronary artery producing acute coronary occlusion and purulent pericarditis.Int J Cardiol. 2007; 114: e81-e82Google Scholar). Usually diagnosed late, these sequelae most often require surgical management. Prolonging antimicrobial therapy may be unnecessary if the treatment of IE has been completed. In the case presented here, clindamycin was maintained for another 6 weeks, as 16S PCR performed on the coronary tissue was positive for S. aureus, even though cultures remained sterile. Funding: None. Ethical approval: Ethical approval was not required. Written consent was obtained from the patient. Conflict of interest: The authors declare that there are no conflicts of interest to disclose." @default.
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- W2810361057 date "2018-08-01" @default.
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- W2810361057 title "Giant mycotic right coronary aneurism: A rare complication of Staphylococcus aureus native valve endocarditis" @default.
- W2810361057 doi "https://doi.org/10.1016/j.ijid.2018.06.017" @default.
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