1/4. Unexpected childhood death due to a rare complication of ventriculoperitoneal shunting.A 10-year-old boy with arnold-chiari malformation, spina bifida, and a ventriculoperitoneal shunt for hydrocephalus died unexpectedly, having appeared to be only mildly unwell with fever on the night before death. At autopsy, the shunt was partially obstructed with an associated enterococcal meningitis. The tip of the shunt was located within the transverse colon, which was embedded in a mass of fibrous adhesions resulting from previous abdominal surgery. blood cultures were sterile. intestinal perforation is a rare complication of ventriculoperitoneal shunting that may be associated with the development of meningitis and unexpected death. The autopsy assessment of children with such indwelling devices requires examination of the functional state of the shunt, full septic workup, and determination of the precise location of the tip of the catheter within the peritoneal cavity.- - - - - - - - - - ranking = 1keywords = autopsy (Clic here for more details about this article) |
2/4. Native quadruple-valve endocarditis caused by enterococcus faecalis.We report the case of a patient with postoperative, hospital-acquired, quadruple-valve endocarditis caused by enterococcus faecalis on presumed normal native valves. During a cervical laminectomy, the patient had a non-ST-elevation myocardial infarction that was treated conservatively. In the intensive care unit, the patient became febrile and developed a new 2/6 systolic murmur. blood cultures grew E. faecalis, and the patient was given antibiotics. Postoperative transthoracic echocardiography and transesophageal echocardiography revealed vegetations on all 4 heart valves. Subsequently, the patient was moved to another facility and died. No autopsy was performed. E. faecalis is the third-most-common cause of bacterial endocarditis overall; however, it is rarely found in multiple-valve, hospital-acquired endocarditis. Although transthoracic echocardiography is a powerful diagnostic tool, transesophageal echocardiography increases the sensitivity and specificity to about 90%. In our patient, the diagnosis of native quadruple-valve endocarditis would not have not been made without the use of transesophageal echocardiography.- - - - - - - - - - ranking = 0.5keywords = autopsy (Clic here for more details about this article) |
3/4. Fatal bacillus cereus endocarditis masquerading as an anthrax-like infection in a patient with acute lymphoblastic leukemia: case report.A 38-year-old male farm worker with relapsing acute lymphoblastic leukemia spontaneously developed an ulcerating ulcer on his anterior thigh which was surrounded by a non-tender area of erythema. bacillus cereus was isolated from the ulcer and blood, and the patient received intravenous penicillin and vancomycin for one week. When sensitivity studies were returned he was treated with gatifloxacin orally. After two weeks of combined antimicrobial therapy and negative blood cultures, the patient received combination chemotherapy with vincristine, prednisone, doxorubicin and cyclophosphamide. He was hospitalized a day after completing chemotherapy with neutropenic sepsis due to B. cereus. He received similar antimicrobial therapy as previously, but died three days later. At autopsy, the patient was found to have acute mitral valve endocarditis and bilateral brain abscesses. This was the first case of B. cereus endocarditis reported in a patient with acute lymphoblastic leukemia.- - - - - - - - - - ranking = 0.5keywords = autopsy (Clic here for more details about this article) |
4/4. Antibiotic-resistant endocarditis in a hemodialysis patient.A chronic dialysis patient developed persistent bacteremia as a result of infection with enterococcus faecium. During the patient's illness, resistance to ampicillin, gentamicin, vancomycin, and teicoplanin developed. Despite arteriovenous (AV) graft removal and an extensive but inconclusive search for the source of the infection, bacteremia persisted. On autopsy, the patient was found to have had aortic-valve endocarditis. endocarditis is a well-known complication in dialysis patients. Multidrug-resistant organisms are becoming more prevalent in hospitalized patients as well. risk factors for the development of endocarditis in dialysis patients include catheters, AV grafts, and calcific valvular disease, all in conjunction with frequent access to the circulation. Avoidance of temporary catheter use by prompt placement of AV fistulas or grafts and consideration of their early use, the meticulous care of catheters once in place, and treatment of the nasal carriage of staphylococcus aureus may lower the incidence of bacteremia and therefore endocarditis in dialysis patients. The removal of infected catheters and/or AV grafts if prompt clearing of the blood with antibiotics does not occur is the next step, followed by valve replacement in selected cases. The routine use of vancomycin in the dialysis population should be reevaluated in light of the development of high-level antibiotic-resistant organisms.- - - - - - - - - - ranking = 0.5keywords = autopsy (Clic here for more details about this article) |