Aortic valve streptococcus group B endocarditis post-extracorporeal shock \nwave lithotripsy
A 55 year old man referred with the chief complaint of frequency and dysuria, and urinary tract infection. Examination of the patient showed 4 to 6 mm renal stones in right kidney, 3 small stones in the left kidney, and also a cortical cyst with 5*6 mm width in the right kidney. Extracorporeal shock wave lithotripsy was done for him and fever progress was observed for 4 days. He was treated with ceftriaxone and his general condition improved slightly, but his fever persisted. Kidney sonography was repeated and showed small 3-4 mm stones in both kidneys without abscess and hydronephrosis. Because of continuing fever and hematuria, with urosepsis diagnosis the patient was admitted and started on antibiotics that contain gentamicin, ciprofloxacin and ceftriaxone, but he was referred to our center because he did not respond to treatment. On admission physical examination was normal except temperature = 39.7 ºC, HR = 90 min, RR = 26 min, Bp = 135/80 mmHg. Hemodynamic pattern and ECG were normal. Fever workup was done for him. Blood culture was positive for streptococci group B in first and third days after admission. Hematologic and serum chemical laboratory data are shown in .\nAlthough cardiac examination was normal, due to continuing fever and bacteremia echocardiography was done to find the source of infection of urinary system and bacteremia. Echocardiography showed normal ejection fraction (60%), mild AI, and vegetation on aortic valve (). Antibiotic therapy was started and continued for 4 weeks.\nAt the end of the course of medical therapy the patient was well and had shown a good response to antibiotic therapy, and thus did not need cardiac surgery. The patient was discharged when blood culture was negative and the level of ESR was decreased. In 2 years follow-up, he was well without any complications.