Valvular vegetation created ...

The patient in the hospital after the introduction of the next dose of heroin was discharged at his own request on the eighth day of hospitalization. Observation of the second. Patient L., aged 22, was admitted to hospital 01/18/2000 with the diagnosis of disseminated process in the lungs collapse. " The patient on admission complained of cough with phlegm trudnootdelyaemoy green, sometimes brownish-bloody color, weakness, sweating, chills, fever up to 38-40 ° C, pain in the knee joints. The above complaints occurred in a patient 30 days before hospitalization. In history - heroin addiction in three years, the last injection was made three days prior to hospitalization. The presence of arthralgia in a patient was regarded as a drug "breaking". During the clinical course of disease the patient developed symptoms of septic state, accompanied by severe intoxication with symptoms of encephalopathy, typical for sepsis hectic fluctuations in body temperature (Fig. 2). On examination the patient revealed the following: 1) bilateral pulmonary destruction caused metitsillinrezistentnym Staphylococcus aureus (according to sputum, blood culture in the growth of pathogens are not detected), 2) bacterial endocarditis with involvement of the tricuspid valve (tricuspid valve anteriorcusp dramatically thickened and condensed, with rough outline, deeply prolapses into the cavity of the right atrium, which is visualized during systole linear formation: Loss of tendinous chords, empowering the heart cavities, ejection fraction - 68%, tricuspid regurgitation III degree), 3) chronic hepatitis C (antigen-positive HCV, PCR - negative), 4), hypochromic anemia, 5) signs of hepatocellular failure (increase in ALT, AST, total bilirubin and related) against severe hepatosplenomegaly, according to the ultrasound of the abdomen. Figure 3. Echocardiography patient L., 22, of the above diseases and syndromes, the greatest danger to life was represented by bacterial endocarditis tricuspid valve with echocardiographic signs of progressive tricuspid regurgitation and extensive infectious vegetations on the valves (Fig. 3). Valvular vegetation created conditions for bacterial embolization to the lungs with development of new pneumonic foci of destruction. Home antibiotic therapy vancomycin (1 g three times a day / in combination with ciprofloxacin 800 mg / day and metronidazole was not effective enough (maintained clinical and laboratory signs of a septic state). After a two-week course of antibiotics the above it was decided to appoint a meron at a dose of 1 g three times a day / in. The treatment meronemom combined with detoxifying and immunotherapy the patient's condition gradually began to improve (decrease in body temperature to subfebrile, normalization of acute phase proteins of blood, the phenomenon disappeared encephalopathy and drugs "breaking").