KEY CLINICAL MESSAGE
Atopic dermatitis may cause infective endocarditis associated with
staphylococci. Generally, Right-sided infective endocarditis responds
well to medication, but our patient had multiple organ failure and
required long-term ICU management.
A 51-year-old man with severe atopic dermatitis (AD) visited our
hospital with high fever and general malaise. On physical examination,
his body temperature was 39.8°C, heart rate was 129/min, blood pressure
was 115/71mmHg, respiratory rate was 25 breaths/min, and oxygen
saturation was 97% under room air. Laboratory tests showed the
following results: white cell count 17,600/µL, C-reactive protein 32.4
mg/dL, and procalcitonin 17.3 ng/mL. Chest computed tomography showed
multiple cavities in bilateral lungs, consistent with septic emboli
(Figure 1). Transthoracic echocardiography revealed a vegetation on the
tricuspid valve (Figure 2). Blood cultures revealed
methicillin-sensitive Staphylococcus aureus .
It is generally reported that right-sided Infective endocarditis (IE)
displays a good response to medical therapy. However, our patient
initially suffered from multiple organ failure, so we performed
long-term ventilation management and blood purification.
IE due to S. aureus occasionally occur in patients with AD,
because AD lesions are often colonized by S. aureus1, and the biofilm is almost ubiquitous in AD lesion
skin. The perivalvular abscess and the valve perforation as S.
aureus -linked IE manifestation of tissue destruction were associated
with high mortality 2.