[HSF] Endocarditis with splenic infarct

[Otto Thaning]

Nand!
Am puzzled about the management of the patient who has a vegetation, positive blood culture and was treated on IV antibiotics and discharged from hospital within  the 2 week period after diagnosis. It is thus assumed the antibiotic treatment was shorter than ideal.

The vegetation needs to be removed and I would recommend a 6 week course of appropriate antibiotic in hospital - a time that would allow you to monitor the splenic infarct. The danger there is the possible development of a splenic abscess.

Otto Thaning
Cape Town

----- Original Message ----- 
From: "nand kejriwal" <nkkejriwal at gmail.com>
To: <OpenHeart-L at lists.hsforum.com>
Sent: Thursday, May 31, 2007 10:30 AM
Subject: Re: [HSF] Endocarditis with splenic infarct


> Dear members
> 
> 47 year man, admitted 2 weeks back with mitral valve endocarditis with
> vegetation. Blood culture - Enterococcus faecalis. Put on Gentamycin and
> Amoxycillin and discahrged. Readmitted 3 days ago with severe abdominal
> pain.
> CT - acute splenic infarct. No evidence of abscess formation. at this stage.
> 
> Repeat TOE - vegetation still the same size.
> Referred to me today. I am planning to operate tomorrow.
> 
> Opinion of the forum regarding splenic infarct. My plan is to leave the
> spleen alone and follow it up in the postop period. What are the chances of
> bleeding into the infarct during heparinisation?  Would anyone recommend
> concomitant splenectomy?
> 
> Thanks
> 
> nand
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