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[Impediment of cellular immune response under treatment with ticlopidine in a patient with Staphylococcus aureus endocarditis].
- Source :
-
Zeitschrift fur Kardiologie [Z Kardiol] 2000 Aug; Vol. 89 (8), pp. 691-7. - Publication Year :
- 2000
-
Abstract
- A 52-year-old male with coronary artery disease was admitted with acute aortic valve endocarditis and a temperature up to 39.5 degrees C caused by Staphylococcus aureus. The patient was treated with ticlopidine (Tiklyd) after percutaneous transluminal coronary angioplasties to reduce restenosis by inhibiting thrombocyte aggregation. Upon admission c-reactive protein (CRP) was 389 mg/l. Interleukin-6 (IL-6) and Interleukin-2-receptor (IL-2-rec) were distinctly increased. Monoclonal antimyocardial antibodies were found. Leukocyte count never exceeded 9.8 G/l; however, transesophageal echocardiography validated a soft vegetation of the aortic valve. Antibiotic therapy was initiated with imipenem, gentamicin and vancomycin; clarithromycin was added after five days. Temperature normalized after 24 days. The c-reactive protein decreased from 389 mg/l to 6 mg/l, and the elevated cytokine levels decreased accordingly. Agranulocytosis or pancytopenia by ticlopidine through a toxic mechanism have been described, which are normally reversible within three weeks; there has not yet been a description of a missing leukocyte response in endocarditis as in this case report. This is a special situation with lack of or impeded immunological response, which limits the use of ticlopidine, especially since a therapeutic alternative with clopidogrel is available.
- Subjects :
- Agranulocytosis chemically induced
Angioplasty, Balloon, Coronary
Anti-Bacterial Agents administration & dosage
Anti-Bacterial Agents therapeutic use
Clarithromycin administration & dosage
Clarithromycin therapeutic use
Coronary Disease prevention & control
Coronary Disease therapy
Drug Therapy, Combination administration & dosage
Drug Therapy, Combination therapeutic use
Echocardiography, Doppler
Endocarditis, Bacterial diagnostic imaging
Endocarditis, Bacterial drug therapy
Endocarditis, Bacterial immunology
Gentamicins administration & dosage
Gentamicins therapeutic use
Humans
Imipenem administration & dosage
Imipenem therapeutic use
Immunity, Cellular immunology
Leukocyte Count
Leukocytes drug effects
Leukopenia chemically induced
Male
Middle Aged
Staphylococcal Infections drug therapy
Staphylococcal Infections immunology
Thienamycins administration & dosage
Thienamycins therapeutic use
Time Factors
Vancomycin administration & dosage
Vancomycin therapeutic use
Endocarditis, Bacterial etiology
Fibrinolytic Agents adverse effects
Immunity, Cellular drug effects
Leukocytes immunology
Platelet Aggregation Inhibitors adverse effects
Staphylococcal Infections etiology
Ticlopidine adverse effects
Subjects
Details
- Language :
- German
- ISSN :
- 0300-5860
- Volume :
- 89
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- Zeitschrift fur Kardiologie
- Publication Type :
- Academic Journal
- Accession number :
- 11013974
- Full Text :
- https://doi.org/10.1007/s003920070197