心室中隔欠損症に合併した三尖弁限局性感染性心内膜炎の1例

A Case of Tricuspid Valvular Infectious Endocarditis Complicated with Ventricular Septal Defect

　症例は17歳，女性．1993年4月24日発熱が出現し，4月28日に当科紹介入院となった．生後7カ月時に心室中隔欠損（VSD）を指摘されたが，放置していた．入院時胸部X線写真は異常なかったが，炎症反応は陽性，血液培養でS．aureusを分離した．PIPCを投与したが解熱せず，胸部X線写真・胸部CT上小空洞陰影が出現し敗血症性塞栓症と考えた．また，心エコーにてVSDと三尖弁に疵贅を認め感染性心内膜炎と診断した．抗菌薬をIPM／CSとMINOに変更後解熱し，胸部X線所見は改善し，心エコーにて心内膜炎の所見も消失した．本症例は心室中隔欠損症に合併した三尖弁限局性感染性心内膜炎であり比較的稀な症例と考えた．

A 17-year-old female, in whom ventricular septal defect was noticed seven months after her birth, had not received medical treatment. She was admitted to our hospital with fever as her chief complaint. A chest roentgenogram showed normal on admission but Sta-phylococcus coccus was isolated from blood culture. In spite of the administration of PIPC (8g/day), her fever continued and a chest roentgenogram and chest comput-ed tomogram showed multiple small cavitations/due to septic emboli. An echocardiogram revealed the pres-ence of ventricular septal defect and vegetation on the tricuspid valve. As she was diagnosed as having infec-tious endocarditis, she was treated by IPM/CS (2g/day) and MINO (200mg/day). Her fever disappeared and her chest roentgenogram and echocardiogram improved after the administration of IPM/CS and MINO.

A case of infectious endocarditis, in which vegetation is present only on the tricuspid valve, is rare.