Peripheral arterial embolism and pyrexia in a young patient without comorbidities.

UNLABELLED: Peripheral arteries embolism can be located in various organs. It can be caused by many medical conditions, diagnosis and treatment of which allows to prevent further complications.

A CASE REPORT: 26-year-old male patient was admitted to the Department of Internal Medicine, Hypertension and Vascular Diseases due to lasting over two months fatigue, recurrent pyrexia, weight loss and abdominal pain. Prior to that, he presented to physician several times. First time because of left foot pain with oedema and fever. USG revealed embolus in anterior tibial artery. Outpatient antibiotic, antithrombotic and anti-inflammatory treatment was given. The symptoms subsided, but appeared in other limb. After a while patient presented with pyrexia, fatigue, abdominal and lumbar region pain and melaena. CT showed infarction of spleen and left kidney. Once again outpatient treatment with amoxicillin with clavulanate was administered. Eventually, at admission to the clinic, infective endocarditis (IE) with dental origin was suspected. Echocardiography showed vegetation on bicuspid aortic valve, causing regurgitation. Blood culture was taken and empiric antimicrobial therapy with ampicillin, gentamicin and cloxacillin was administered. Blood culture was positive for Streptococcus sanguinis. Carious teeth were extracted, then the aortic valve replacement surgery was performed. Ampicillin was replaced with vancomycin, and gentamicin was continued. After the surgery, patient's condition improved. He was discharged on demand without completing antibiotic treatment, so he had follow-up appointment and IE prophylaxis recommended.

CONCLUSIONS: Despite peripheral embolism is common manifestation of IE, this disease is relatively rare and not suspected in young people. The symptoms can be non-specific, what makes diagnosis challenging, as described in this case.