Vancomysin Case

Background: A 22-year-old healthy college student was experiencing a loss of appetite, fever, night sweats, joint pain and skin rashes during the month of February 2014. The patient had lost approximately 18 pounds and had a constant feeling of malaise. In attempts to diagnose the patient, doctors tried to rule out multiple autoimmune disorders such as Addison’s disease, Lupus, Leukemia, and Rheumatoid arthritis. Extensive blood work was taken with no prominent results except for an increased sedimentation rate. After multiple visits to different physician clinics and no diagnosis, the patient scheduled an appointment with their pediatrician on March 2014. Upon review of patient documentation, the pediatrician referred the patient for an emergency
visit to a pediatric cardiovascular physician 24 hours later. At the emergency visit to the pediatric cardiologist on March 2014, results showed a normal Electrocardiogram (EKG) and a 2-D echocardiogram (echo) showing a bicuspid aortic valve with moderate aortic regurgitation and mild LV enlargement. In addition, cardiac vegetation in the sub-aortic ventricular septal region was suggested. Differential Diagnosis: Major arterial emboli, septic pulmonary infarcts, and mycotic aneurysm. Treatment: The patient was immediately transported and admitted to Miami Children’s Hospital on March 2015 after the diagnosis of bacterial endocarditis was made. The patient was placed in the Cardiac Intensive Care Unit (CICU) and prescribed intravenous antibiotics that same evening. A blood culture test was done, the bacteria alpha Streptococcus was identified.
Vancomysin continued to be administered for three days every 12 hours due to the intensity and amount of bacteria and Gentamicin was introduced every eight hours. In addition, Ceftriaxone (Rocephin) was administered every four hours followed by Benadryl because the patient was allergic to Penicillin. After spending eight days in the hospital the patient went through a minor surgical procedure to implant a peripherally inserted central catheter (PICC) line and sent home to continue antibiotic treatment for 33 days. The patient later returned for another echo and the vegetation was no longer present. On May 2014 the patient had the PICC line removed and was told to begin light cardiovascular rehabilitation with no weight lifting until finally cleared on September 2015. Uniqueness: The most unique component of this case study was that the bacteria had a cultivation time of twelve hours and thirty minutes in comparison to a normal cultivation of >48-72 hours. Conclusion: It is important for Athletic Trainers to be educated in this pathology and its symptoms. EKG and echocardiograms are not part of Pre-Participation Examinations and therefore cardiac anomalies might be
missed.