Question

• Patient is a 43 year old female with a history of Tetrad Fallot and mitral valve prolapse • Admitted to hospital with chief complaint of intermittant fevers, weight loss, fatigue and headaches for the past 3 months • Had dental surgery 4 months ago but there were no complications appearing after that surgery and she was not given any antibiotics

• Further data on patient Ms. "X": • Small skin lesions and hemorrhages in the nail beds • Blood cultures grew Gram positive cocci in chains from all four blood culture bottles taken
What is your diagnosis (what do you suspect?)
A. Tuberculosis
B. Depression
C. Bacteremia and endocarditis
D. Septicemia

Answer 1

The patient's symptoms and medical history point towards a diagnosis of subacute bacterial endocarditis, likely related to bacteria entering the bloodstream during her dental surgery.

Step-by-step explanation:

The patient's history of Tetralogy of Fallot and mitral valve prolapse, combined with symptoms of intermittent fevers, weight loss, fatigue, headaches, skin lesions, hemorrhages in nail beds, and blood cultures growing Gram positive cocci in chains, is highly suggestive of bacteremia and endocarditis. The dental surgery four months prior might have been a significant event despite the absence of immediate complications, as oral flora can enter the bloodstream during dental procedures and potentially infect cardiac structures, particularly in patients with pre-existing heart conditions who did not receive prophylactic antibiotics. Considering all clinical symptoms and the blood culture results, the diagnosis leans towards subacute bacterial endocarditis (SBE), a form of endocarditis that has a more insidious onset and may be less aggressive compared to its acute counterpart.