Rare case of Proteus mirabilis native mitral valve endocarditis in an immunocompromised patient [Case Report]
Grossman, Lindsay G; Sharkey, Joseph M; Grossman, David S; Hartman, Alan; Makaryus, Mina; Shah, Kaushal B
BACKGROUND:Bacterial infective endocarditis caused by Proteus mirabilis is rare and there are few cases in the literature. The natural history and treatment of this disease is not as clear but presumed to be associated with complicated urinary tract infection (cUTI). CASE PRESENTATION/METHODS:A 65-year-old female with a history of rheumatoid arthritis, factor V Leiden hypercoagulability, and prior saddle pulmonary embolism presented to the emergency department following a mechanical fall. Computed Tomography showed evidence of acute/subacute splenic emboli. Complicated UTI was likely secondary to a ureteral stone. Blood and urine cultures also grew out P. mirabilis. Transthoracic echocardiography revealed a mobile echogenic density on the anterior mitral valve (MV) leaflet consistent with a vegetation. The patient underwent MV replacement, and P. mirabilis was isolated from the surgically removed valve. CONCLUSIONS:We hypothesize that the patient's immunocompromised status following steroid and Janus Kinase inhibitor usage for rheumatoid arthritis contributed to Gram-negative bacteremia following P. mirabilis UTI, ultimately seeding the native MV. Additional studies with larger numbers of Proteus endocarditis cases are needed to investigate an association between immunosuppression and Proteus species endocarditis.
Clinical Outcomes in Patients for Whom Precertification for Myocardial Stress Perfusion Imaging Was Not Obtained Using Algorithms Based On ACC/AHA/ASNC Guidelines and Appropriateness Criteria [Meeting Abstract]
Reichek, Nathaniel; Grossman, David; Amico, Russell; Gerstenblith, Gary; Brinker, Jeffrey A; Winters, Stephen; Calkins, Hugh; Han, Jing; Covert, John; Levine, Joseph
Determinants of the impact of guideline based review 826-5 on utilization of myocardial stress perfusion imaging: Roles of self-referral, physician specialty, patient age and type of insurance. [Meeting Abstract]
Reichek, Nathaniel; Grossman, David; Amico, Russell; Gerstenblith, Gary; Brinker, Jeffrey A.; Winters, Stephen; Calkins, Hugh; Han, Jing; Levine, Joseph
Initial effect of guideline implementation on utilization of myocardial stress perfusion imaging [Meeting Abstract]
Reichek, Nathaniel; Grossman, David; Amico, Russell; Gerstenblith, Gary; Brinker, Jeffrey; Winters, Stephen; Calkins, Hugh; Han, Jing; Covert, John; Levine, Joseph
Pseudorecurrence of paroxysmal supraventricular tachycardia after radiofrequency catheter ablation
Grossman, D S; Cohen, T J; Goldner, B; Jadonath, R
Over an 11-month period (November 1992 to October 1993), 32 radiofrequency catheter ablations were performed for recurrent symptomatic supraventricular tachycardia in 17 patients with atrioventricular (AV) nodal reentry, 13 with AV reentry with an accessory pathway), and 2 with both AV and AV nodal reentry. Each patient underwent both diagnostic and therapeutic electrophysiologic study with radiofrequency catheter ablation in a single session. Twelve of the 32 patients had recurrent symptoms after catheter ablation. A repeat study was performed in 9 of the 12 patients. At 7.7 +/- 0.8 months (range 4 to 11) of follow-up only one patient had had a true symptomatic recurrence. Additional sessions of ablation cured this patient. We conclude that pseudorecurrence of paroxysmal supraventricular tachycardia is a common phenomenon in patients after radiofrequency catheter ablation. Follow-up electrophysiologic study demonstrates and helps differentiate pseudo from true paroxysmal supraventricular tachycardia recurrence.
Treating thyroid related cardiovascular disorders
Grossman, David S; Klein, Irwin