Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 16, 2021; 9(17): 4348-4356
Published online Jun 16, 2021. doi: 10.12998/wjcc.v9.i17.4348
Coronary sinus endocarditis in a hemodialysis patient: A case report and review of literature
Hui-Jeong Hwang, Sung-Wook Kang
Hui-Jeong Hwang, Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul 05278, South Korea
Sung-Wook Kang, Department of Pulmonary, Allergy and Critical Care Medicine, Kyung Hee University Hospital at Gangdong, Seoul 05278, South Korea
Author contributions: Hwang HJ drafted the manuscript and reviewed the literature; Kang SW was the patient’s medical doctor and contributed to interpret clinical findings of the patient; all authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient’s legal guardian for publication of this report and any accompanying image.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hui-Jeong Hwang, MD, PhD, Associate Professor, Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, 892 Dongnam-ro, Gangdong-gu, Seoul 05278, South Korea. neonic7749@khu.ac.kr
Received: January 20, 2021
Peer-review started: January 20, 2021
First decision: February 11, 2021
Revised: February 23, 2021
Accepted: April 12, 2021
Article in press: April 12, 2021
Published online: June 16, 2021
Processing time: 126 Days and 8.2 Hours
Abstract
BACKGROUND

Infective endocarditis is more common in hemodialysis patients than in the general population and is sometimes difficult to diagnose. Isolated coronary sinus (CS) vegetation is extremely rare and has a good prognosis, but complicated CS vegetation may have a poorer clinical course. We report a case of CS vegetation accidentally found via echocardiography in a hemodialysis patient with undifferentiated shock. The CS vegetation may have been caused by endocardial denudation due to tricuspid regurgitant jet and subsequent bacteremia.

CASE SUMMARY

A 91-year-old man with dyspnea and hypotension was transferred from a nursing hospital. He was on regular hemodialysis and had a history of severe grade of tricuspid regurgitation. There was no leukocytosis or fever upon admission. Repetitive and sequential blood cultures revealed absence of microorganism growth. Chest computed tomography showed lung consolidation and a large pleural effusion. A mobile band-like mass on the CS, suggestive of vegetation, was observed on echocardiography. We diagnosed him with infective endocarditis involving the CS, pneumonia, and septic shock based on echocardiographic, radiographic, and clinical findings. Infusion of broad-spectrum antibiotics, fluid resuscitation, inotropic support, and ventilator care were performed. However, the patient died from uncontrolled infection and septic shock.

CONCLUSION

CS vegetation can be fatal in hemodialysis patients with impaired immune systems, especially when it delays the diagnosis.

Keywords: Coronary sinus; Endocarditis; Renal dialysis; Echocardiography; Diagnosis, differential; Case report

Core Tip: Coronary sinus vegetation is rarely observed. It might also be confused with a coronary sinus thrombosis and inappropriately managed. We present a case of coronary sinus vegetation with typical echocardiographic findings and review clinical challenges, including differential diagnoses and therapeutic options, associated with treating hemodialysis patients suspected to have coronary sinus endocarditis.