A strange lump on the hand of a Vancouver man turned out to be a sign of a life-threatening infection that has already spread to the heart. What could have caused the infection?
Hand Lump In The Emergency Department
A report in the New England Journal of Medicine details the ordeal of a young man who came into the emergency department with a strange lump on his hand, which turned out to be a sign of a life-threatening condition. When he came to the emergency department, the 27-year-old's main complaint was of abdominal pain and a pulsing lump in his hand. Evidently, the lump on his hand began as a localized red zone, but in two short weeks, turned blue and raised, and began pulsing.
Further, he also reportedly experienced fever, decreased appetite, and a 12-kilogram (26-pound) weight loss in the last six weeks. Upon the young man's examination, doctors found a 38 degrees Celsius temperature, increased white blood cell count, and a strange heart murmur.
Further testing revealed that the lump was actually an ulnar-artery mycotic aneurysm wherein one of the hand's blood vessels had become swollen and had affected his spleen and left kidney. Further, echocardiogram revealed vegetations or clumps on his bicuspid aortic valve while blood cultures tested positive for Streptococcus salivarius, leading his doctors to diagnose him with subacute bacterial endocarditis.
Endocarditis And Oral Health Connection
Endocarditis is the infection of the inner linings of the heart chambers and heart valves, and it normally happens when bacteria, germs, or fungi from other parts of the body spread through the blood and attach to the heart. If left untreated, this could lead to the destruction of the heart valves and cause serious life-threatening complications.
In the young man's case, the bacterial infection triggered his body's aggressive response to it, as manifested by the flu-like symptoms. His treatment involved aortic-valve replacement, surgical repair of the mycotic aneurysm, and a six-week course of ceftriaxone, which alleviated the fever and night sweats in just two days. The patient was able to recover fully, though he is now required to take antibiotics before undergoing any dental procedure.
In regard to how he might have contracted the infection, it could possibly be linked to a recent dental procedure and years of lacking oral hygiene in that the bacteria might have entered his bloodstream through openings in the mouth. Further, he apparently had an undiagnosed mild heart irregularity, and his heart was found to have just two valves instead of the usual three. The circumstances together made him prone to the infection that could have led to severe consequences had it not been given the proper treatment.