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Two Cases of Infective Endocarditis with Multiple Brain Infarcts Caused by Streptococcus agalactiae
Jinyong Park, M.D.1, Su Nyoung Choi, M.D.1, Hyun Ok Kim, M.D.1, Yong Geun Jeong, M.D.1Jin Yong Hwang, M.D.1, Jong Woo Kim, M.D.2 and In-Gyu Bae, M.D.1
Department of Internal Medicine1, Thoracic and Cardiovascular Surgery2, College of Medicine, Gyeongsang National University, Jinju, Korea
Vol.38 Num.5 (p271~276)
The higher incidence of Streptococcus agalactiae infection in the newborns and pregnant women had been well recognized. The incidence of invasive S. agalactiae infection was recently increasing in both elderly adults and those with comorbid conditions such as diabetes mellitus, liver cirrhosis, malignancy, and abnormalities in immune responses. We report our experience with two diabetic middle-aged men who suffered from S.agalactiae infective endocarditis. Case 1) A 58-year-old man with diabetes mellitus and chronic alcoholism presented with fever and both lower legs weakness. An echocardiography showed two vegetations on the mitral valve. S. agalactiae was identified from blood cultures. He was treated with penicillin G and gentamicin, and he underwent mitral valve replacement surgery because of persistent fever and newly developed brain infarcts. One month later, an amputation of the left lower leg was performed for the embolic gangrene of left lower leg. Case 2) A 57-year-old diabetic man was admitted to our hospital because of fever and left shoulder pain. He had received the incision and drainage to treat left shoulder joint septic arthritis, but he had a continuous fever. On 5th day of admission, culture of pus from the left shoulder joint revealed S. agalactiae. An echocardiography showed a vegetation on the posterior mitral leaflet. He was treated with penicillin G and gentamicin. On 18th day of admission, a mitral valve replacement surgery was performed. He was discharged without recurrence.
Keywords : Streptococcus agalactiae, Infective endocarditis, Cerebral embolism