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Washington University Experience | VASCULAR | Aneurysm - Infective (Mycotic) | 7A0 Case 7 History
Case 7 History ---- This patient was a 49 year old man with a history of IV heroin abuse, a hand abscess, hepatitis C, mitral valve endocarditis with annular abscess status post mitral valve replacement (8/2013) and embolic stroke who represented on 12/10/13 with nausea and vomiting. In the ER, he became hypotensive with a systolic blood pressure in the 70s and developed tachycardia to the 130s. For respiratory failure, he was intubated and he was put on broad spectrum antibiotics until his cultures grew staphylococcus aureus. His initial troponin was 3.24 and he was started on a heparin drip for a NSTEMI. At the OSH, he was reportedly weaned from pressors and his mental status improved. A trans-esophageal echocardiogram was performed that showed mobile masses on the lateral aspect of the prosthetic mitral valve annulus that were highly suspicious for vegetations. The patient’s condition worsened. An MRI on 12/12/13 demonstrated a large acute left frontal intraparenchymal hemorrhage with intraventricular extension. There was 1.8 cms of midline shift, as well as uncal, transtentorial, and tonsillar herniation. He was transferred to BJH where on arrival his pupils were fixed and unequal; he had no cough, gag, or corneal reflexes. The patient was declared brain dead shortly thereafter.
