A 29-year-old man was admitted to our hospital because of high
fever and
dyspnea. About two months before this admission the patient was diagnosed as Henoch-Schönlein
purpura nephritis who was treated with 40 mg/day of
prednisolone(PSL). When the dose of PSL was decreased to 32.5 mag/day, his temperature was 40 degrees C, the pulse was 120 beats per minute and the blood pressure was 71/36 mmHg. In the peripheral blood study, the white blood cell count was 23,800/microL and
C-reactive protein was 6.1 mg/dL. He was diagnosed as bilateral lower lung
pneumonia by chest-computed tomography findings, non-segmental and high-density consolidation of the bilateral lower lungs. Streptococcus pneumoniae was detected from blood culture. Therefore it was concluded that
sepsis was caused by severe
pneumonia. Thereafter
infective endocarditis was diagnosed from the findings of vegetation of both the tricuspid and mitral valves detected by ultrasonic cardiography.
Infective endocarditis resulted from
septicemia caused by Streptococcus pneumoniae. The
infection related
endocarditis was completely healed by early treatment including an adequate quantity of
penicillin G with high sensitivity. There have been few case reports of
infective endocarditis in patients with
nephritis under
steroid therapy.
Steroid therapy is widely used in patients with various types of
nephritis including
IgA nephropathy and focal segmental glomerular
sclerosis in addition to Henoch-Shönlein
purpura.
Infective endocarditis should be recognized as a complication of
steroid treatment of these patients.