Mesenteric pseudoaneurysm and cerebral stroke as sequelae of infective endocarditis in an adolescent.

Abstract

Infective endocarditis is uncommon in children, and there is a paucity of literature concerning cases that involve unique or resistant organisms. Complications associated with infective endocarditis are distinctly rare and poorly characterized, especially unusual sequelae such as pseudoaneurysm of the abdominal mesentery. Our case involves an adolescent who presented with several weeks of fever and eventual cardiac murmur and was found to have vancomycin-resistant Enterococcus growing as a vegetation on a previously undiagnosed bicuspid aortic valve. He had a cerebral stroke presenting as Broca's aphasia before cardiac surgery, as well as a superior mesenteric artery pseudoaneurysm several days postoperatively. The case highlights some of the serious surgical complications that can occur in young persons with infective endocarditis, as well as many of the problems involved in managing a patient with highly resistant pathogens and a surgically challenging location of the aneurysm.

• Authors: Eric J Dziuban, Daniel H Teitelbaum, Arsala Bakhtyar, Jyoti Kandlikar, Sean McLean, Sai Yarram, Mark W Russell, Richard G Ohye, Ramon Sanchez
• Journal: Journal of pediatric surgery (J Pediatr Surg) Vol. 43 Issue 10 Pg. 1923-7 (Oct 2008) ISSN: 1531-5037 [Electronic] United States
• PMID: 18926234 (Publication Type: Case Reports, Journal Article)

Chemical References

• Anti-Bacterial Agents

Topics

• Adolescent
• Aneurysm, False (etiology, surgery)
• Aneurysm, Infected (etiology, surgery)
• Anti-Bacterial Agents (therapeutic use)
• Aortic Valve (abnormalities, microbiology, surgery)
• Aphasia, Broca (etiology)
• Combined Modality Therapy
• Endocarditis, Bacterial (complications, drug therapy, surgery)
• Enterococcus (drug effects, isolation & purification)
• Gram-Positive Bacterial Infections (complications, drug therapy, surgery)
• Heart Valve Prosthesis Implantation
• Humans
• Infarction, Middle Cerebral Artery (etiology)
• Intracranial Embolism (etiology)
• Male
• Mesenteric Artery, Superior (pathology, surgery)
• Pulmonary Valve (surgery, transplantation)
• Streptococcal Infections (complications, drug therapy, surgery)
• Vancomycin Resistance