Staphylococcal endocarditis presenting with a renal infarct in a patient with acute lymphoblastic leukemia

Acute Lymphoblastic Leukemia with Infective Endocarditis Presented with Unusual Intracardiac Mass

Acute lymphoblastic leukemia (ALL) is a systemic disease that is presented with different symptoms and signs. Cardiac manifestation is rare in ALL, but it is very important and needs appropriate management. It usually presents as leukemic myocardial infiltration and in the presence of cardiac mass comprehensive evaluation for other etiologies is mandatory. We reported on a 6-year-old boy in remission phase of ALL and large cardiac mass in the right atrium with obscure early symptoms and signs, in whom infective endocarditis (IE) was diagnosed and appropriate medical treatment was performed. Because the mass was sustained, surgical resection was considered for the patient.

Infective endocarditis presenting with loin pain

A 28-year-old previously healthy man presented to a peripheral hospital several hours after onset of acute right flank pain. A kidney stone was suspected clinically as the patient was otherwise well appearing, afebrile and normotensive. Renal function was normal and urinalysis showed no haematuria or white blood cells. A contrast CT scan of the abdomen revealed a filling defect in the ventral branch of the right renal artery with no distal perfusion suggesting a renal embolus. Subsequent investigations revealed blood cultures positive for coagulase negative staphylococcus and echocardiogram showed a bicuspid aortic valve, a dilated aortic root and moderately dilated ascending aorta. The patient was transferred to a tertiary care hospital and transesophageal echocardiogram revealed severe aortic insufficiency and thickening of the aortic valve suggestive of endocarditis. Following antibiotic treatment, blood cultures became negative and the patient underwent successful semi-urgent aortic root replacement. Renal function remained normal throughout.