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Boavida L, Carvalho JA, Batista F, Oliveira S, Alves J. Infective Aortic Valve Endocarditis in a Patient With Mixed Connective Tissue Disease. Cureus 2021; 13:e20681. [PMID: 34966624 PMCID: PMC8710065 DOI: 10.7759/cureus.20681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2021] [Indexed: 11/21/2022] Open
Abstract
Mixed connective tissue disease (MCTD) is a rare autoimmune disorder that is characterized by overlapping clinical features of systemic lupus erythematosus (SLE), scleroderma, and myositis. Both SLE and mixed connective tissue disease patients are more prone to have acute endocarditis, and immunosuppression is a risk factor for recurrence of infective endocarditis. We present the case of a 53-year-old female with mixed connective tissue disease presenting with interstitial lung disease and precapillary pulmonary hypertension. The patient was chronically medicated with prednisolone, mycophenolate mofetil, and hydroxychloroquine. She was admitted for Enterococcus faecalis infective endocarditis and was treated with a four-week course of ceftriaxone and ampicillin. Immunosuppressive chronic medication was maintained due to severe lung involvement. One month later, the patient was re-admitted due to respiratory infection with identification of influenza B virus. However, fever persisted for over one week, and subsequent relapse of the E. faecalis infective endocarditis was found. The diagnosis was made based on blood cultures and a transoesophageal echocardiogram. No other focus of infection was identified. She completed a six-week course of vancomycin and gentamicin and underwent cardiac surgery with success. This case highlights the difficulty of the management of immunosuppressed patients in the presence of serious infections.
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Affiliation(s)
- Leonor Boavida
- Department of Internal Medicine IV, Hospital Professor Doutor Fernando Fonseca, Lisbon, PRT
| | - Joana Azevedo Carvalho
- Department of Internal Medicine IV, Hospital Professor Doutor Fernando Fonseca, Lisbon, PRT
| | - Frederico Batista
- Department of Internal Medicine IV, Hospital Professor Doutor Fernando Fonseca, Amadora, PRT
| | - Susana Oliveira
- Department of Internal Medicine IV, Hospital Professor Doutor Fernando Fonseca, Lisbon, PRT
| | - José Alves
- Department of Internal Medicine IV, Hospital Professor Doutor Fernando Fonseca, Lisbon, PRT
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Ihara K, Rai T, Naito S, Toda T, Sasaki S, Uchida S, Matsui N. Infective endocarditis in a patient with lupus nephritis who was undergoing immunosuppressive therapy: A case of survival. J Rural Med 2017; 12:139-145. [PMID: 29255533 PMCID: PMC5721300 DOI: 10.2185/jrm.2936] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 07/07/2017] [Indexed: 11/27/2022] Open
Abstract
Systemic lupus erythematosus is an autoimmune disease associated with mild valvular
regurgitation. However, there have been no detailed reports of infective endocarditis in
patients with systemic lupus erythematosus. Here, we describe a case of a 55-year-old
woman without any cardiac abnormalities who was diagnosed with lupus nephritis by renal
biopsy; she contracted infective endocarditis while receiving immunosuppressive therapy.
Our case emphasizes that special consideration of the occurrence of infective
endocarditis, and its early diagnosis and treatment are mandatory for patient survival. We
propose that echocardiography should be performed before treating patients with systemic
lupus erythematosus who have an uncertain cardiac status.
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Affiliation(s)
- Katsuhito Ihara
- Department of Nephrology, Tsuchiura Kyodo General Hospital, Japan
| | - Tatemitsu Rai
- Department of Nephrology, Tokyo Medical and Dental University, Japan
| | - Shotaro Naito
- Department of Nephrology, Tokyo Medical and Dental University, Japan
| | - Takayuki Toda
- Department of Nephrology, Tsuchiura Kyodo General Hospital, Japan
| | - Sei Sasaki
- Department of Nephrology, Tokyo Medical and Dental University, Japan
| | - Shinichi Uchida
- Department of Nephrology, Tokyo Medical and Dental University, Japan
| | - Noriaki Matsui
- Department of Nephrology, Tsuchiura Kyodo General Hospital, Japan
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Chang YS, Chang CC, Chen YH, Chen WS, Chen JH. Risk of infective endocarditis in patients with systemic lupus erythematosus in Taiwan: a nationwide population-based study. Lupus 2017; 26:1149-1156. [PMID: 28420053 DOI: 10.1177/0961203317694260] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Objectives Patients with systemic lupus erythematosus are considered vulnerable to infective endocarditis and prophylactic antibiotics are recommended before an invasive dental procedure. However, the evidence is insufficient. This nationwide population-based study evaluated the risk and related factors of infective endocarditis in systemic lupus erythematosus. Methods We identified 12,102 systemic lupus erythematosus patients from the National Health Insurance research-oriented database, and compared the incidence rate of infective endocarditis with that among 48,408 non-systemic lupus erythematosus controls. A Cox multivariable proportional hazards model was employed to evaluate the risk of infective endocarditis in the systemic lupus erythematosus cohort. Results After a mean follow-up of more than six years, the systemic lupus erythematosus cohort had a significantly higher incidence rate of infective endocarditis (42.58 vs 4.32 per 100,000 person-years, incidence rate ratio = 9.86, p < 0.001) than that of the control cohort. By contrast, the older systemic lupus erythematosus cohort had lower risk (adjusted hazard ratio 11.64) than that of the younger-than-60-years systemic lupus erythematosus cohort (adjusted hazard ratio 15.82). Cox multivariate proportional hazards analysis revealed heart disease (hazard ratio = 5.71, p < 0.001), chronic kidney disease (hazard ratio = 2.98, p = 0.034), receiving a dental procedure within 30 days (hazard ratio = 36.80, p < 0.001), and intravenous steroid therapy within 30 days (hazard ratio = 39.59, p < 0.001) were independent risk factors for infective endocarditis in systemic lupus erythematosus patients. Conclusions A higher risk of infective endocarditis was observed in systemic lupus erythematosus patients. Risk factors for infective endocarditis in the systemic lupus erythematosus cohort included heart disease, chronic kidney disease, steroid pulse therapy within 30 days, and a recent invasive dental procedure within 30 days.
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Affiliation(s)
- Y S Chang
- 1 Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,2 Division of Allergy, Immunology, and Rheumatology, Shuang Ho Hospital, Taipei Medical University, Taiwan
| | - C C Chang
- 1 Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,3 Division of Rheumatology, Immunology and Allergy, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Y H Chen
- 4 Biostatistics Center, College of Management, Taipei Medical University, Taiwan
| | - W S Chen
- 5 Division of Rheumatology, Immunology, and Allergy, Taipei Veterans General Hospital, Taiwan
| | - J H Chen
- 6 Biostatistics Center and Graduate Institute of Data Science, College of Management, Taipei Medical University, Taiwan
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Hung TH, Hsieh YH, Tseng KC, Tsai CC, Tsai CC. The risk for bacterial endocarditis in cirrhotic patients: a population-based 3-year follow-up study. Int J Infect Dis 2013; 17:e391-3. [PMID: 23352807 DOI: 10.1016/j.ijid.2012.12.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 12/10/2012] [Accepted: 12/13/2012] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND We noted only rare reports of cirrhotic patients with bacterial endocarditis (BE). There is insufficient data on the risk of BE in liver cirrhosis. This is the first national population-based study evaluating the risk of BE in cirrhotic patients. METHODS We used the National Health Insurance Database, which is derived from the Taiwan National Health Insurance Program. The study cohort comprised 40803 patients with cirrhosis and the comparison cohort consisted of 40841 randomly selected subjects with a similar age and sex distribution. RESULTS Of the total 81644 patients, 192 (0.24%) experienced BE during the 3-year follow-up period, 121 patients from the study cohort (0.30% of the cirrhotic patients) and 71 patients from the comparison group (0.17% of non-cirrhotic patients) (p<0.001). After adjusting for patient age, sex, and comorbid disorders, the Cox regression analysis showed that cirrhotic patients had a high risk of BE compared to non-cirrhotic patients during the 3-year follow-up period (hazard ratio 2.04, 95% confidence interval 1.61-2.44, p<0.001). CONCLUSION We conclude that liver cirrhosis is a risk factor for the occurrence of BE.
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Affiliation(s)
- Tsung-Hsing Hung
- Division of Gastroenterology, Department of Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
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Abstract
This article focuses on the pathogenesis of the gender gap of autoimmune disease. Specifically, the discussion characterizes the role of sex hormones in the immune response and a female predilection for the common diseases seen in daily practice (ie, lupus erythematosus, myasthenia gravis, and other autoimmune diseases). A comparison between the sexes, with respect to autoimmune disease mechanisms, is presented to give oral and maxillofacial surgeons a better insight as to the role of sex and successful surgical treatment outcomes in this population of patients.
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Affiliation(s)
- Andrea Schreiber
- Department of Oral and Maxillofacial Surgery, New York University College of Dentistry, 345 East 24th Street, New York, NY 10010, USA.
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Kam AYL, Chung WC, Luk WK. Oral rehabilitation of a patient with scleroderma associated with systematic lupus erythematosus: a case report. SPECIAL CARE IN DENTISTRY 2006; 26:121-3. [PMID: 16774190 DOI: 10.1111/j.1754-4505.2006.tb01435.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This case report presents a patient who had a limited oral opening due to systematic lupus erythematosus (SLE) and describes how oral rehabilitation was achieved with a removable partial denture. Various techniques for the delivery of oral health care have been reported for patients who have limited mouth openings as a result of SLE and scleroderma. After a review of the literature, a new approach was required for this patient with SLE who had a very limited mouth opening. The retention for the removable partial denture (RPD) used the undercut in the abutment teeth and a magnet-retained sectional RPD. A set of tweezers was modified to help with the insertion and removal of the sectional RPD by the patient. This paper reports a new clinical and laboratory technique of fabricating a sectional RPD using magnets and customized tweezers for this patient.
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Affiliation(s)
- A Y L Kam
- The University of Hong Kong, Pokfulam
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Armstrong D, Wright S, McVeigh C, Finch M. Infective endocarditis complicating rituximab (anti-CD20 monoclonal antibody) treatment in an SLE patient with a past history of Libman–Sacks endocarditis: a case for antibiotic prophylaxis? Clin Rheumatol 2005; 25:583-4. [PMID: 16222410 DOI: 10.1007/s10067-005-0031-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2005] [Accepted: 04/05/2005] [Indexed: 11/25/2022]
Abstract
We report a 54 year old female whose successful treatment of cerebral lupus with rituximab was complicated by the development of streptococcus intermedius, on valves damaged by Libman-Sacks endocarditis more than 20 years previously.
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Affiliation(s)
- David Armstrong
- Department of Rheumatology, Musgrave Park Hospital, Belfast, Northern Ireland.
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Brennan MT, Valerin MA, Napeñas JJ, Lockhart PB. Oral manifestations of patients with lupus erythematosus. Dent Clin North Am 2005; 49:127-41, ix. [PMID: 15567365 DOI: 10.1016/j.cden.2004.07.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Lupus erythematosus manifests as cutaneous variants, such as discoid lupus erythematosus or systemic lupus erythematosus. Systemic lupus erythematosus is a multisystem autoimmune disease characterized by general autoantibody production and a wide range of mucocutaneous, renal, neuropsychiatric, cardiovascular, infectious, and hematologic manifestations. This article discusses the prevalence of and considerations for oral mucosal lesions in lupus erythematosus and the impact of the various disease manifestations of systemic lupus erythematosus on dental management.
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Affiliation(s)
- Michael T Brennan
- Department of Oral Medicine, Carolinas Medical Center, 1000 Blythe Boulevard, Charlotte, NC 28232, USA.
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Abstract
Valvular involvement is the most encountered form of heart disease in systemic lupus erythematosus (SLE). Immunoglobulin and complement deposition in the valvular structure will subsequently lead to Libman-Sacks vegetations, valve thickening, and valve regurgitation. Valvular stenosis is rarely seen. Involvement of the mitral valve is most frequently encountered. Valve disease for most patients is mild and asymptomatic, but patients in whom severe mitral regurgitation develops will present with symptoms of congestive heart failure. A heart murmur will be heard in almost all patients with moderate or severe regurgitation. Transesophageal echocardiography is the most sensitive method to detect the valvular involvement. The valvular changes, the hemodynamic status, or the symptomatology have been shown to progress, remain stable, or sometimes improve. Severe regurgitation, infective endocarditis, and thromboembolic events (mostly stroke or transitory ischemic attacks) are complications of valvular involvement in SLE. In treatment of these patients, prophylaxis of infectious endocarditis, selective antiaggregant and anticoagulant medication, and valve replacement are currently offered. The role of corticosteroid treatment is still unclear in the outcome of SLE valvulopathy.
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Affiliation(s)
- Adrian Fluture
- Department of Medicine/Internal Medicine, New York Medical College/Metropolitan Hospital Center, 1901 First Avenue, New York, NY 10029, USA
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Abstract
Periodontists are often called upon to provide periodontal therapy for patients with a variety of cardiovascular diseases. Safe and effective periodontal treatment requires a general understanding of the underlying cardiovascular diseases, their medical management, and necessary modifications to dental/periodontal therapy that may be required. In this informational paper more common cardiovascular disorders will be discussed and dental management considerations briefly described. This paper is intended for the use of periodontists and members of the dental profession.
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Lockhart PB, Brennan MT, Fox PC, Norton HJ, Jernigan DB, Strausbaugh LJ. Decision-making on the use of antimicrobial prophylaxis for dental procedures: a survey of infectious disease consultants and review. Clin Infect Dis 2002; 34:1621-6. [PMID: 12032898 DOI: 10.1086/340619] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2001] [Revised: 01/28/2002] [Indexed: 11/04/2022] Open
Abstract
There is debate concerning use of antibiotic prophylaxis before invasive dental procedures for patients at risk of acquiring distant site infection (DSI). We determined the opinions and practices of infectious disease consultants (IDCs) regarding antimicrobial prophylaxis to prevent DSIs that result from invasive dental procedures by conducting a survey of the 797 members of the Infectious Diseases Society of America Emerging Infections Network (477 members [60%] responded). Ninety percent of respondents closely follow the American Heart Association guidelines for antibiotic prophylaxis for patients with valvular heart disease who undergo invasive dental procedures. In contrast, few IDCs recommend prophylaxis for patients with lupus erythematosus, poorly controlled diabetes mellitus, dialysis catheters or shunts, cardiac pacemakers, or ventriculoperitoneal shunts. Twenty-five percent to forty percent of respondents recommended prophylaxis for prosthetic vascular grafts, orthopedic implants, or chemotherapy-induced neutropenia. We conclude that IDCs differ considerably in their assessment of the need for prophylaxis for patients who have noncardiac risk factors for DSI. These differences underscore the need for definitive studies to delineate appropriate candidates for antimicrobial prophylaxis in dental practice.
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Affiliation(s)
- Peter B Lockhart
- Department of Oral Medicine, Carolinas Medical Center, Charlotte, NC, 28232, USA.
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Sirois DA, Fatahzadeh M. Valvular heart disease. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2001; 91:15-9. [PMID: 11174565 DOI: 10.1067/moe.2001.111550] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- D A Sirois
- Department of Oral Medicine, Division of Biological Sciences, Medicine, and Surgery, New York University College of Dentistry, New York, NY, USA.
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