[HSF] Endocarditis with splenic infarct

[prasannasimha]

This is the poster that Roberto had presented some time back and had 
sent to me.
Prasanna
Otto Thaning wrote:
> 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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