Ischemic hepatitis with infectious endocarditis: A case report

Okano,Hiroshi; Okado,Ryo; Ito,Hisato; Asakawa,Hiroki; Nose,Kenji; Tsuruga,Satomi; Tochio,Tomomasa; Kumazawa,Hiroaki; Sakuno,Takashi; Isono,Yoshiaki; Tanaka,Hiroki; Matsusaki,Shimpei; Sase,Tomohiro; Saito,Tomonori; Mukai,Katsumi; Nishimura,Akira

doi:10.3892/br.2021.1473

Ischemic hepatitis with infectious endocarditis: A case report

Authors:
- Hiroshi Okano
- Ryo Okado
- Hisato Ito
- Hiroki Asakawa
- Kenji Nose
- Satomi Tsuruga
- Tomomasa Tochio
- Hiroaki Kumazawa
- Takashi Sakuno
- Yoshiaki Isono
- Hiroki Tanaka
- Shimpei Matsusaki
- Tomohiro Sase
- Tomonori Saito
- Katsumi Mukai
- Akira Nishimura
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Affiliations: Department of Gastroenterology, Suzuka General Hospital, Suzuka, Mie 513‑8630, Japan, Department of Cardiology, Suzuka General Hospital, Suzuka, Mie 513‑8630, Japan, Department of Thoracic and Cardiovascular Surgery, School of Medicine, Mie University, Tsu, Mie 514‑8507, Japan
Published online on: September 22, 2021 https://doi.org/10.3892/br.2021.1473
Article Number: 97
Copyright: © Okano et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

A 58‑year‑old woman was admitted to Suzuka General Hospital with fever. She was diagnosed with infectious endocarditis based on the presence of anterior mitral leaflet vegetation on the echocardiography analysis and isolation of Pseudomonas guariconensis by blood culture. During treatment, the hepatic enzymes levels, including aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH) and alkaline phosphatase (ALP) were increased without any abdominal symptoms. Prolonged prothrombin time (PT) and prothrombin time international normalized ratio were observed, and acute hepatic failure was diagnosed. However, the hepatic injury resolved spontaneously with restoration of the PT value after the hepatic enzymes (AST, ALT, LDH and ALP) peaked. Diffusion‑weighted imaging of hepatic magnetic resonance imaging showed diffuse high intensity of the entire liver except for part of the left lobe. The hepatic injury was diagnosed as ischemic hepatitis caused by embolization from the vegetation associated with infectious endocarditis. The recovery from hepatic ischemia was thought to be due to hepatic blood supply from extrahepatic collateral blood. After antibiotic treatment, the patient underwent resection of the vegetation on the anterior mitral valve leaflet. Hepatic artery occlusion is rare, but it may cause severe hepatic complications. During follow‑up of infectious endocarditis, clinicians should be aware of the potential for whole organ ischemic damage caused by vessel occlusion, as well as hepatic ischemic damage.

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