1. Successful management of a complicated clinical crisis
- Author
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Xu, Peipei, Zeng, Hui, Zhou, Min, Ouyang, Jian, Chen, Bing, and Zhang, Qiguo
- Subjects
Adult ,Methicillin-Resistant Staphylococcus aureus ,infectious endocarditis ,daptomycin ,Endocarditis, Bacterial ,Staphylococcal Infections ,Combined Modality Therapy ,Lymphohistiocytosis, Hemophagocytic ,Anti-Bacterial Agents ,hemophagocytic lymphohistiocytosis ,Humans ,Female ,Clinical Case Report ,methicillin-resistant Staphylococcus epidermidis ,multidisciplinary team ,Research Article - Abstract
Rationale: Hemophagocytic lymphohistiocytosis (HLH) secondary to methicillin-resistant Staphylococcus epidermidis (MRSE)-related left-sided infectious endocarditis had never been reported before. In the last decade, daptomycin, a novel lipopeptide antibiotic, showed its excellent role in anti-Gram-positive bacteria, including soft tissue infection, bloodstream and deep tissueinfection. Patient concerns: An Asian women under sever condition due to the cooccurrence of HLH and MRSE-related endocarditis while also be allergic to vancomycin. The patient was cured by high-dose daptomycin monotheraphy, HLH-2004 protocol and cardiothoracic surgery to remove the valve at last, and was obviously benefit from the endeavor of a multidisciplinary team (MDT) strategy. Diagnoses: IE was made on March 27according to the modified Duke criteria. HLH was diagnosed too. Interventions: The patient was cured by high-dose daptomycin monotheraphy, HLH-2004 protocol and cardiothoracic surgery to remove the valve at last, and was obviously benefit from the endeavor of a multidisciplinary team (MDT) strategy. Outcomes: The patient was healthy andstable when we published this case. Lessons: This case proves high-dose daptomycin monotheraphy could be used as an effective alternative regimen for vancomycin in treating MRSE-related left-sided endocarditis and highlight the importance of early diagnosis and appropriate management for HLH. Furthermore, our work suggests an MDT model as a practical strategy in managing similar clinical situation.
- Published
- 2017