Cancer Res Treat.  2008 Sep;40(3):151-154.

Staphylococcal Endocarditis Presenting with a Renal Infarct in a Patient with Acute Lymphoblastic Leukemia

Affiliations
  • 1Department of Pediatrics, Gyeongsang National University College of Medicine, Jinju, Korea. espark@gsnu.ac.kr

Abstract

We present here a patient with acute lymphoblastic leukemia (ALL) and who developed infective endocarditis during induction chemotherapy with prednisolone, L-asparaginase (Leunase(R)), vincristine and adriamycin. The patient did not have a history of a central venous catheter. Sharp flank pain and fever occurred on the 25th day of induction chemotherapy. In addition, a renal infarct and movable vegetations on the mitral valve were detected on the abdominal computed tomography (CT) and echocardiography. S. aureus was identified in the cultured blood. While the patient achieved remission, follow-up echocardiography revealed the vegetation had in-creased in size and an abscess pocket had developed despite the antibiotics and heparin therapy. Consequently, ten days after the diagnosis of infective endocarditis, a successful mitral valvuloplasty was performed without complications. The patient is currently on maintenance chemotherapy while in remission.

Keyword

Precursor cell lymphoblastic leukemia-lymphoma; Staphylococcus aureus; Vegetation; Coagulation

MeSH Terms

Abscess
Anti-Bacterial Agents
Central Venous Catheters
Doxorubicin
Echocardiography
Endocarditis
Fever
Flank Pain
Follow-Up Studies
Heparin
Humans
Induction Chemotherapy
Maintenance Chemotherapy
Mitral Valve
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Prednisolone
Staphylococcus aureus
Vincristine
Anti-Bacterial Agents
Doxorubicin
Heparin
Prednisolone
Vincristine

Figure

  • Fig. 1 An abdominal CT showed a right renal infarct on the 1st day.

  • Fig. 2 TTE findings. (A) A baseline TTE that was performed before chemotherapy commenced. (B) The TTE revealed infective endocarditis. The size of the vegetation was 14×5.5 mm.

  • Fig. 3 Eight days after the first CT, a second abdominal CT revealed multiple splenic infarcts.


Reference

1. Gonzalez-Barca E, Carratala J, Mykietiuk A, Fernandez-Sevilla A, Gudiol F. Predisposing factors and outcome of Staphylococcus aureus bacteremia in neutropenic patients with cancer. Eur J Clin Microbiol Infect Dis. 2001; 20:117–119. PMID: 11305464.
2. Mugge A, Daniel WG, Frank G, Lichtlen PR. Echocardiography in infective endocarditis: reassessment of prognostic implications of vegetation size determined by the transthoracic and the transesophageal approach. J Am Coll Cardiol. 1989; 14:631–638. PMID: 2768712.
3. Rohmann S, Seifert T, Erbel R, Jakob H, Mohr-Kahaly S, Makowski T, et al. Identification of abscess formation in native-valve infective endocarditis using transesophageal echocardiography: implications for surgical treatment. Thorac Cardiovasc Surg. 1991; 39:273–280. PMID: 1785114.
Article
4. Alberts SR, Bretscher M, Wiltsie JC, O'Neill BP, Mokri B, Witzig TE. Thrombosis related to the use of L-asparaginase in adults with acute lymphoblastic leukemia: a need to consider coagulation monitoring and clotting factor replacement. Leuk Lymphoma. 1999; 32:489–496. PMID: 10048421.
Article
5. Shapiro AD, Clarke SL, Christian JM, Odom LF, Hathaway WE. Thrombosis in children receiving L-asparaginase. Determining patients at risk. Am J Pediatr Hematol Oncol. 1993; 15:400–405. PMID: 8214362.
6. Mitchell LG, Andrew M, Hanna K, Abshire T, Halton J, Anderson R, et al. A prospective cohort study determining the prevalence of Thrombotic Events in Children with Acute Lymphoblastic Leukemia and a Central Venous Line Who are Treated with L-Asparaginase: results of the Prophylactic Antithrombin Replacement in Kids with Acute Lylmhoblastic Leukemia Treated with Asparaginase (PARKAA) Study. Cancer. 2003; 97:508–516. PMID: 12518376.
7. Unal S, Varan A, Yalcın B, Buyukpamukcu M, Gurgey A. Evaluation of thrombotic children with malignancy. Ann Hematol. 2005; 84:395–399. PMID: 15735962.
Article
8. Mattsson E, Hartung T, Morath S, Egesten A. Highly purified lipoteichoic acid from Staphylococcus aureus induces procoagulant activity and tissue factor expression in human monocytes but is a weak inducer in whole blood: comparison with peptidoglycan. Infect Immun. 2004; 72:4322–4326. PMID: 15213184.
9. Mattsson E, Herwald H, Bjorck L, Egesten A. Peptidoglycan from staphylococcus aureus induces tissue factor expression and procoagulant activity in human monocytes. Infect Immun. 2002; 70:3033–3039. PMID: 12010995.
10. Drake TA, Rodgers GM, Sande MA. Tissue factor is a major stimulus for vegetation formation in enterococcal endocarditis in rabbits. J Clin Invest. 1984; 73:1750–1753. PMID: 6427279.
Article
11. Veltrop MH, Beekhuizen H. Monocytes maintain tissue factor activity after cytolysis of bacteria-infected endothelial cells in an in vitro model of bacterial endocarditis. J Infect Dis. 2002; 186:1145–1154. PMID: 12355366.
Article
12. Korkmaz S, Ileri M, Hisar I, Yetkin E, Kosar F. Increased levels of soluble adhesion molecules, E-selectin and P-selectin, in patients with infective endocarditis and embolic events. Eur Heart J. 2001; 22:874–878. PMID: 11350097.
Article
13. Alberts SR, Bretscher M, Wiltsie JC, O'Neill BP, Mokri B, Witzig TE. Thrombosis related to the use of L-asparaginase in adults with acute lymphoblastic leukemia: a need to consider coagulation monitoring and clotting factor replacement. Leuk Lymphoma. 1999; 32:489–496. PMID: 10048421.
Article
14. Shapiro AD, Clarke SL, Christian JM, Odom LF, Hathaway WE. Thrombosis in children receiving L-asparaginase. Determining patients at risk. Am J Pediatr Hematol Oncol. 1993; 15:400–405. PMID: 8214362.
15. Baddour LM, Wilson WR, Bayer AS, Fowler VG Jr, Bolger AF, Levison ME, et al. Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America. Circulation. 2005; 111:e394–e434. PMID: 15956145.
Full Text Links
  • CRT
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr