Abstract: FR-PO011

A Stitch in Time Saves Nine: Renal Infarction Secondary to Forgotten Prophylaxis

Session Information

Category: Nephrology Education

  • 1302 Fellows and Residents Case Reports

Authors

  • Leghrouz, Muhannad, University of Florida, Gainesville, Florida, United States
  • Chornyy, Volodymyr, University of Florida, Gainesville, Florida, United States
  • Koratala, Abhilash, University of Florida, Gainesville, Florida, United States
Background

Antibiotic prophylaxis against bacterial endocarditis is indicated prior to invasive procedures in patients with certain high-risk cardiac conditions and thorough history needs to be elicited prior to performing such procedures. We present a case of spleno-renal infarction secondary to septic emboli in a patient with prosthetic aortic valve who underwent a dental procedure without endocarditis prophylaxis.

Methods

A 42-year-old white man with history of bioprosthetic aortic valve presented with intermittent fevers for a week and bilateral flank pain for 2 days. He saw a dentist 2 weeks ago for toothache and underwent a dental procedure involving manipulation of gingival tissue. Exam was significant for systolic murmur in the aortic area and tenderness in bilateral flanks. Serum LDH was elevated. A CT scan of the abdomen with contrast demonstrated areas of non-enhancement involving more than 50% of the right kidney predominantly involving the lower pole and also most of the spleen consistent with renal and splenic infarction [Figure 1a]. Interestingly, the patient was noted to have an accessory right renal artery providing flow to the upper part and probably accounts for relative sparing of this portion of the kidney [Figure 1b]. Subsequently, patient’s blood cultures grew Streptococcus mitis and oralis; trans-esophageal echo revealed infective endocarditis, which supports the diagnosis of renal and splenic infarction from septic emboli. Patient improved with antibiotic therapy and renal function remained stable.

Conclusion

The learning point from our case is that thorough history taking before invasive procedures might prevent potentially life-threatening complications. Our patient had prosthetic valve, and appropriate antibiotic prophylaxis prior to the dental procedure could have evaded the complications he developed.

Figure 1a and 1b