Red eye, blurry vision, and cough
The 48-year-old patient also has chills and a low-grade fever. How would you proceed with his care?
The patient in this case had a repeat transesophageal echocardiogram at 2 months, and it showed a rupture in the mitral valve from the small vegetation, with worsening of regurgitation. The cardiothoracic surgeon attempted repair of the mitral valve, but ended up having to replace it. The infectious disease team recommended a 6-week course of vancomycin, which the patient finished.
The sensorineural hearing loss in the patient’s left ear was profound and did not improve after a course of oral prednisone. Magnetic resonance imaging showed labyrinthitis secondary to septic emboli. He received 2 transtympanic injections of dexamethasone, but his hearing still did not improve. The otolaryngology staff has discussed the possibility of a bone-anchored hearing aid. At a recent visit to the eye clinic, the patient had no light perception in the affected eye, despite an absence of active infection. Enucleation of the eye is being discussed.
CORRESPONDENCE: Egambaram Senthilvel, MD, FRCSEd, MetroHealth Medical Center, Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH 44109; senthilvelegambaram@yahoo.com
