急性下肢動脈閉塞を契機に診断された感染性心内膜炎の1例

Infective Endocarditis Diagnosed After Acute Arterial Occlusion of the Lower Extremity：Report of a Case

はじめに　感染性心内膜炎は致死的疾患であり，早期発見および治療介入が重要である．主要合併症の一つに塞栓症があるが，中枢神経系や腹腔臓器への分枝の塞栓が多く，下肢動脈の塞栓は比較的まれである．われわれは，急性下肢動脈閉塞を契機に診断することができた感染性心内膜炎の1例を経験したので報告する．

A 73-year-old male was admitted to our hospital due to fever and right lower limb pain. Contrast-enhanced computed tomography （CT） revealed occlusion from the right common femoral artery to the right superficial femoral artery and from the left common iliac artery to the left internal and external iliac arteries, leading to a diagnosis of bilateral acute arterial occlusion of the lower extremity. Emergency thrombectomy was performed to improve arterial blood flow. However, the patient continued to experience persistent fever and blood culture results were positive, prompting further investigation for the source of infection. Echocardiography revealed vegetations on the mitral valve and infective endocarditis with embolic complications was diagnosed. Because of the presence of residual vegetation, urgent mitral valve replacement was performed. The patient experienced no recurrence of infection postoperatively and was discharged home on continued oral antibiotic therapy.