Ann Dermatol.  2019 Feb;31(1):70-74. 10.5021/ad.2019.31.1.70.

Two Cases of Infective Endocarditis in Patients with Atopic Dermatitis

• Park BW
• Shin YS
• Cho EB
• Park EJ
• Kim KH
• Kim KJ

• KMID: 2430804
• DOI: http://doi.org/10.5021/ad.2019.31.1.70

Abstract

Patients with atopic dermatitis have high rates of skin surface colonization of Staphylococcus aureus. At the same time, S. aureus is the major causative organism in infective endocarditis, approximately accounting for 30%~50% cases of infective endocarditis. A 22-year-old male with severe atopic dermatitis presented with fever and myalgia. He was diagnosed with active infective endocarditis causing multiple cerebral infarction, splenic infarction, and septic shoulder requiring synovectomy. Blood culture proved methicillinsensitive Staphylococcus aureus bacteremia, and the culture from the skin revealed same bacteria. After treated with intravenous antibiotics for 6 weeks, patient was improved. Another 42-year-old female with severe atopic dermatitis who presented with fever and chilling was hospitalized due to acute infective endocarditis. She also had left flank pain and visual disturbance, due to splenic infarction and acute cerebral infarction, respectively. As blood culture revealed methicillin-sensitive Staphylococcus aureus bacteremia, she treated with intravenous antibiotics for 6 weeks. The route of entry of two patients was attributed to the patient eczematous scratching lesion of poorly controlled atopic dermatitis. Infective endocarditis can result in the context of acute deterioration of atopic dermatitis. Dermatologists need to pay attention to this risk and actively manage such conditions in order to decrease the risk of infective endocarditis arising from skin lesions in atopic patients. For these reasons, we herein report two cases of infective endocarditis in patients with atopic dermatitis.

Keyword

Atopic dermatitis; Infective or Infectious endocarditis; Staphylococcus aureus

MeSH Terms

Adult
Anti-Bacterial Agents
Bacteremia
Bacteria
Cerebral Infarction
Colon
Dermatitis, Atopic*
Endocarditis*
Female
Fever
Flank Pain
Humans
Male
Myalgia
Shoulder
Skin
Splenic Infarction
Staphylococcus aureus
Young Adult
Anti-Bacterial Agents

Figure

• 

  Fig. 1 Osler nodes, Janeway lesions, and splinter hemorrhages are observed on the hands on the patient 1. We received the patient's consent form about publishing all photographic materials.

• 

  Fig. 2 (A) Echocardiography of the patient 1. It showed 1.7×0.6 cm sized hypermobile echogenic material attatched to mitral valve, which indicates intracardiac vegetation. (B) Magnetic resonance imaging (MRI) scan of the shoulder of the patient 1. It revealed septic arthritis which requires surgical intervention. (C) Computed tomography scan of the abdomen of the patient 2. It indicates acute pyelonephritis of the left kidney. (D) MRI scan of the brain of the patient 2. Multiple cerebral infraction attributed to embolism can be observed.

Reference

1. Boguniewicz M, Leung DY. Atopic dermatitis: a disease of altered skin barrier and immune dysregulation. Immunol Rev. 2011; 242:233–246. PMID: 21682749.

2. Boguniewicz M, Leung DY. Recent insights into atopic dermatitis and implications for management of infectious complications. J Allergy Clin Immunol. 2010; 125:4–13. PMID: 20109729.

3. Hauser C, Wuethrich B, Matter L, Wilhelm JA, Sonnabend W, Schopfer K. Staphylococcus aureus skin colonization in atopic dermatitis patients. Dermatologica. 1985; 170:35–39. PMID: 3972149.

4. Mylonakis E, Calderwood SB. Infective endocarditis in adults. N Engl J Med. 2001; 345:1318–1330. PMID: 11794152.

5. Ahn K. The prevalence of atopic dermatitis in Korean children. Allergy Asthma Immunol Res. 2016; 8:1–2. PMID: 26540495.

6. Lee JH, Han KD, Kim KM, Park YG, Lee JY, Park YM. Prevalence of atopic dermatitis in Korean children based on data from the 2008-2011 Korean National Health and Nutrition Examination Survey. Allergy Asthma Immunol Res. 2016; 8:79–83. PMID: 26540505.

7. Aly R, Maibach HI, Shinefield HR. Microbial flora of atopic dermatitis. Arch Dermatol. 1977; 113:780–782. PMID: 141239.

8. Patel D, Jahnke MN. Serious complications from Staphylococcal aureus in atopic dermatitis. Pediatr Dermatol. 2015; 32:792–796. PMID: 26337792.

9. Harada M, Nishi Y, Tamura S, Iba Y, Abe K, Yanbe Y, et al. [Infective endocarditis with a huge mitral vegetation related to atopic dermatitis and high serum level of infectionrelated antiphospholipid antibody: a case report]. J Cardiol. 2003; 42:135–140. PMID: 14526663.

10. Yamamoto T, Yodogawa K, Wakita S, Ogano M, Tokita M, Miyagi Y, et al. Recurrent prosthetic valve endocarditis caused by Staphylococcus aureus colonizing skin lesions in severe atopic dermatitis. Intern Med. 2007; 46:571–573. PMID: 17473491.

11. Grabczynska SA, Cerio R. Infective endocarditis associated with atopic eczema. Br J Dermatol. 1999; 140:1193–1194. PMID: 10354109.

12. Pike MG, Warner JO. Atopic dermatitis complicated by acute bacterial endocarditis. Acta Paediatr Scand. 1989; 78:463–464. PMID: 2741691.

13. Satchell AC, Barnetson RS. Staphylococcal septicaemia complicating treatment of atopic dermatitis with mycophenolate. Br J Dermatol. 2000; 143:202–203. PMID: 10886168.

14. Beneson S, Zimhony O, Dahan D, Solomon M, Raveh D, Schlesinger Y, et al. Atopic dermatitis--a risk factor for invasive Staphylococcus aureus infections: two cases and review. Am J Med. 2005; 118:1048–1051. PMID: 16164895.

15. Mohiyiddeen G, Brett I, Jude E. Infective endocarditis caused by Staphylococcus aureus in a patient with atopic dermatitis: a case report. J Med Case Rep. 2008; 2:143. PMID: 18454875.

16. Micallef MJ, Ramphul A. Infective endocarditis in a patient with atopic dermatitis. J Cardiol Cases. 2016; 13:153–154. PMID: 30546632.

17. Horimoto K, Kubo T, Matsusaka H, Baba H, Umesue M. Right-sided infective endocarditis with a ruptured sinus of Valsalva and multiple septic pulmonary emboli in a patient with atopic dermatitis. Intern Med. 2015; 54:797–800. PMID: 25832944.

18. Fukunaga N, Okada Y, Konishi Y, Murashita T, Koyama T. Pay attention to valvular disease in the presence of atopic dermatitis. Circ J. 2013; 77:1862–1866. PMID: 23535217.

19. Ong PY, Ohtake T, Brandt C, Strickland I, Boguniewicz M, Ganz T, et al. Endogenous antimicrobial peptides and skin infections in atopic dermatitis. N Engl J Med. 2002; 347:1151–1160. PMID: 12374875.