Is there a place for corticosteroids in the therapy of infective endocarditis? Report of a case and review.

tp://dx.doi.org/10.1016/j.hjc.2017 09-9666/a 2017 Hellenic Society of ense (http://creativecommons.org/ Infective endocarditis (IE) is a lethal infection even in the era of antibiotic therapy and cardiovascular surgery. The clinical course of IE varies from an uncomplicated infection with minor valve damage to a fulminant life-threatening condition. Although immunological phenomena are present in IE there is no clinical evidence on the use of immunomodulatory therapies. Is immunomodulation beneficial or harmful in IE? We present a case of a successful outcome of a patient with IE to whom corticosteroids were given along with antimicrobial treatment. Case-report: A 42 year old man was diagnosed with IE by Enterococcus faecalis according to the DUKE criteria. The patient had a history of Bentall type surgery three years ago because of acute aortic dissection in Marfan syndrome. Echocardiography detected a slight paravalvular leakage of the prosthetic aortic valve along with a 11mm zonular aortic vegetation that had prolapsed into the left ventricular outflow area (Figure 1). Pulmonary artery systolic pressure was 15mmHg and left ventricular cardiac ejection fraction was 60%. No immunological complications of IE were present. The patient was given ampicillin (12gr/24h) plus gentamicin 1mg/kg/24h. An initial partial remission of fever was achieved, but fever relapsed (39 C) on the 4 day of treatment. Simultaneously the patient developed a fulminant purpuric macular rash without demasquation or skin detachment that progressed from the trunk and the chest to the distal extremities. Peripheral blood