Table 1
Baseline characteristics of the two patients with pneumococcal Osler’s triad
| Characteristic | Patient 1 | Patient 2 |
|---|---|---|
| AV, atrioventricular; CSF, cerebrospinal fluid; ICU, intensive care unit; MIC, minimum inhibitory concentration. | ||
| Age | 51 years | 70 years |
| Sex | Male | Female |
| Underlying disease | Hypertension, peripheral arteriopathy | – |
| Primary localisation | Pneumonia and meningitis | Pneumonia and meningitis |
| Endocarditis features | 24 hour delayed diagnosis, aortic endocarditis, large vegetation; massive aortic insufficiency, perivalvular abscess, interatrial communication | 28 hour delayed diagnosis, mitral endocarditis, small vegetation, moderate mitral insufficiency |
| Empirical intravenous antimicrobial chemotherapy | Amoxicillin (2 g/4 h), cefotaxime (2 g/4 h), vancomycin (2 g/day) | Cefotaxime (2 g/4 h), vancomycin (2 g/day) |
| Combined treatment | – | Dexamethasone (10 mg/6 h) |
| Isolation of Streptococcus pneumoniae | Blood, vegetation, CSF (culture), bronchoalveolar fluid | Blood, vegetation, CSF (Gram stain+culture), bronchoalveolar fluid |
| S pneumoniae MIC | Penicillin sensitive, amoxicillin: <0.5 µg/ml | Penicillin resistant, amoxicillin: 5 µg/ml; cefotaxime: 4 µg/ml |
| Adapted antimicrobial treatment | Amoxicillin, gentamicin | Rifampicin, vancomycin |
| Evolution | Septic and cardiogenic shocks and III AV block, acute | Septic shock, subacute |
| Organ failure | Neurological, respiratory, haemodynamic, renal, disseminated intravascular coagulopathy | Neurological, respiratory, haemodynamic, renal |
| Vasopressor support (µg/kg/min) | Dobutamine (15), noradrenaline (1.2), isoprenaline (10 µg/min) | Dobutamine (5), noradrenaline (0.5) |
| Corticosteroids, 7 days | Hydrocortisone (200 mg/day), fludrocortisone (50 µg/day) | Hydrocortisone (200 mg/day), fludrocortisone (50 µg/day) |
| Surgical treatment | Aortic valve substitution | – |
| ICU length before discharge | 5 weeks | 3 weeks |
| Mental status at ICU discharge | Moderate disability | Normal |
