SINDROMUL ARTICULAR N ENDOCARDITA INFECIOAS, CAZ CLINIC Ruslan

Ridcodubschi, Natalia Spancioc, Elena Samohvalov, Mihai Curudimov, Valeria Evtodiev.

Disciplina Cardiologie, Clinica Medical nr.3, Departamentul Medicin Intern,
USMF Nicolae Testemianu
Conductori: Alexandra Grejdieru, conf. un.,d.m., Livi Grib, prof. un., d.h.
Rezumat

Endocardita infecioas (EI) este o maladie grav cu incidena de 3-10 episoade la 100.000
persoane pe an, stabilirea tardiv a diagnosticului (36-40%), complicaii fatale: insuficien cardiac
congestiv n 30%, fenomene embolice n 20%, accident vascular cerebral n 15%. Manifestrile
articulare la pacienii cu EI sunt rare, manifestate prin: artrit 6,4%, sinovite 2,8% i creaz
dificulti n stabilirea precoce a diagnosticului.
Materiale i metode: Pacientul Y., 47 ani, Diagnostic: Endocardita infecioas activ cu
hemoculturi negative, cu afectarea valvelor native (valva aortic (VAo), mitral (VM) i a arterei
pulmonare (AP)), Insuficiena VM de gradul III, VAo gr.II, VAp gradul II, IC II NYHA.
Periodontit cronic. Hepatita cronic de etiologie viral (HCV), activitate moderat.
Rezultate: subfebrilitate, dispnee inspiratorie, palpitaii, durere de severitate medie-sever n
articulaiile umrului, cotului, articulaia coxofemural, lumbalgii, astenie. Obiectiv: peteii
tegumentare, tumefiere regiunilor periarticulare, zgomotele cardiace ritmice, atenuate, TA-135/60
mmHg. FCC-105 b/min. n plmni murmur vezicular. ECG: Tahicardie sinusal cu frecvena de
102 bti pe minut. AEC orizontal. EcoCG: Dilatarea moderat a AS, VD, AD. FE 65 %.
Vegitaii plate, flotante pe cuspa anterioar i posterioar a VM (7x10 mm), vegeta ii flotante pe
cuspele VAo, insuficiena VM de gr. III, VAo gr. II, VTr gr. III, VAp. gr. I, HTP moderat,
PsVD 36 mmHg. Analiza general de snge: anemie (Hb 102 g/l), VSH 40 mm/or. Analiza
biochimica: Bilirubina total 25 mmol/l, ALAT 49,9 mmol/l, ASAT 66,9 mmol/l, GGT 295,4
U/l. Analiza general de urin: leucociturie, Testele imunologice: Anti-HCV pozitiv, factor
reumatoid 44 UI/ml, proteina C-reactiv 384 mg/l. Hemocultura - negativ.
Tratament antimicrobian empiric cu sol. Vancomicin 60 mg/kg/zi, i/v n 2-3 prize, Sol.
Gentamicin 3 mg/kg/zi i/v ntr-o singur doz, antimicotice, remedii antiinflamatoare
nesteroidiene, diuretice.
Concluzii: Pacient tnr de 47 de ani cu bacteriemie oral cronic dezvolt EI cu sindrom
poliarticular n debut, ce creaz dificulti n stabilirea precoce a diagnosticului i temporizeaz
tratamentul antimicrobian adecvat.
 JOIN-INVOLVEMENT IN INFECTIVE ENDOCARDITIS, CLINICAL CASE
Ruslan Ridcodubschi, Natalia Spancioc, Elena Samohvalov, Mihai Curudimov, Valeria
Evtodiev.
The discipline of Cardiology, Medical Clinic nr.3, Departament Internal Medicine,
SUMP "Nicolae Testemitanu", Chisinau, Republic of Moldova.

Academic adviser: Alexandra Grejdieru, M.D., PhD, Associated of Professor, M.D., Livi Grib
M.D., PhD, Professor

Summary infectious Endocarditis (IE) is a serious disease with incidence of 3-10 to 100.000
episodes per year, late diagnosis establishing (36-40%), fatal complications: congestive heart failure
in 30%, embolic phenomena in 20%, stroke 15%. Joint manifestations in patients with IE are rare,
they are manifested by: arthritis-6.4%, sinovitis-2.8% and creates difficulties in establishing early
diagnosis.
Materials and methods: Patient Y., 47 years old, Diagnosis: Active Infectious Endocarditis
with negative hemocultures with native valve involvement(aortic valve (AoV), mitral (MV) and the
pulmonary artery (PA)), MV failure of III degree, AoV II degree, VAp II degree, HF II NYHA.
Chronic Periodontitis. Chronic hepatitis of viral etiology (HCV), moderate activity.
Results: subfebrility inspiratory dyspnea, palpitations, pain of the mean-severe severity in
shoulder joint, elbow joint, coxofemural joint, lumbalgias, fatigue. Objective: tegumental
peteschias, tumefiation of the periarticular regions, rhytmic heart beats, atenuated, BP-135/60
mmHg. FCC-105 b/min. Vesicular murmur in lungs. ECG: Sinusal tachycardia with frequency of
102 beats per minute. EAH - horizontal. EcoCG: Moderate dilatation of LA, RV, RA. EF-65%.
Plate vegitations, floating on the anterior and posterior cusps and MV (7 x 10 mm), floating
vegetations of the AoV cusps, MV failure, III degree, AoV-II degree, TrV-III degree, ApV-I degree,
moderate PHT, PsVD-36 mmHg. General blood analysis: anemia (Hb-102 g/l), ESR-40 mm/HR.
Biochemical analysis: total bilirubin 25 mmol/l, ALT-49.9 mmol/l, AST-66.9 mmol/l, GGT U/l-
295.4. General urine analysis: leucocitury, immunological tests: Anti-HCV-positive, rheumatoid
factor-44 IU/ml, C-reactive protein-384 mg/l. Negative hemocultures.
Empirical antimicrobial treatment with sol. Vancomycin-60 mg/kg/day, i/v in 2-3 plugs,
Sol. Gentamicin-3 mg/kg/day, i/v in a single dose, antifungal, antiinflammatory drugs, diuretics.
Conclusions: Patient 47-year-old young man with chronic oral bacteriemia develops IE with
polyarticular syndrome from the begining, that creates difficulties in early diagnosis establishing
and lates appropriate antimicrobial treatment.
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