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

Affiliations
  • 1Department of Dermatology, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, Anyang, Korea. dermakkh@naver.com

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.


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