PULMONARY VALVE ENDOCARDITIS, BILATERAL D EEP-VEIN THROMBOSIS AND RECURRENT PULMONARY EMBOLI

A 57-year-old obese man with hypertensive heart disease and long-stand ing varicose veins developed recurrent bouts of fever, lung infiltrati ons, cardiac arrhythmias and increasing dyspnoea. On admission multipl e lung emboli and bilateral deep vein thromboses were confirmed. The e chocardiogram demonstrated floating vegetations on all three pulmonary valve cusps. Biochemical tests indicated an inflammatory constellatio n (ESR 62/105 mm, C-reactive protein 13.3 mg/dl), partial respiratory insufficiency (pO2 54.6 mm Hg; PCO2 29 mm Hg). Streptococcus bovis was grown from several blood cultures. Conservative treatment over severa l weeks, complicated by >>drug fever<<, with penicillin G (10 mega IU four times daily) and gentamicin (80 mg twice daily intravenously), la ter vancomycin (500 mg four, times daily intravenously), then roxythro mycin (150 mg three times daily by mouth), as well as maintenance anti coagulation with heparin (800-1,200 IU/h intravenously, later 15,000 I U subcutaneously twice daily), followed by phenprocoumon, contained th e disease. One year after onset of treatment a good functional results had been achieved.