Gustav Mahler: betrayed love and endocarditis lenta

Gustav Mahler (1860-1911), a renown Austrian composer, died of subacute bacterial endocarditis, when antibiotic treatment was not yet available. Earlier in his life, he developed a mitral stenosis with systolic murmur which was a legacy of frequent throat infections and rheumatic fever which he had as a child. This condition was diagnosed accidentally when he was age forty-seven. Throughout his adult life, however, Mahler was asymptomatic and became a very successful conductor and musical director, as well as a prolific composer. His preoccupation with fate and death was notorious, probably having its roots in many deaths of his young siblings. The fatal blow came in a form of betrayal by his beloved wife, Alma, who had a love affair with a younger man. This sudden abandonment constituted a severe emotional stress, which superimposed on other past and present adverse events in his life, weakened his immune system. He developed bacteraemia-cum-endocarditis and finally succumbed to a cruel fate, a theme that repeatedly appears in his music.Key wordsMahler, endocarditis, betrayal, immune system, fate

Fatal outcome of first case of Streptococcus sinensis in infective endocarditis in the Netherlands: a case report

Background Infective endocarditis is a relatively common disease in a cardiologist’s daily practice. Nowadays more detailed information about pathogens is provided to us by diagnostics such as MALDI Biotyper Massa Spectrometer. We present a case of endocarditis lenta in which Streptococcus sinensis was identified in the Netherlands for the first time. Case summary A 58-year-old man was admitted with high suspicion of endocarditis lenta complicated by severe kidney dysfunction and anaemia. He was treated with penicillin and gentamycin. Transthoracic echocardiogram revealed a large vegetation at the mitral valve and MALDI Biotyper Massa Spectrometer (Microflex) revealed S. sinensis as the pathogen. The patient refused to receive blood transfusions or surgery. Due to cerebral infarction with haemorrhagic transformation, the patient died 8 days after admission. Discussion Streptococcus sinensis was described in Hong Kong for the first time and is associated with endocarditis in rheumatic heart disease. To our knowledge, this is the first case reporting a fatal outcome of endocarditis due to this bacterium in the acute phase. In this case, late discovery, disease severity, and under treatment all contributed to the poor outcome. We want to share the knowledge on the existence of this bacteria.

Endocarditis lenta-patient survived septic shock: a case report

Infective endocarditis is defi ned as an infection of the endocardial surface of the heart. Its intracardiac effects include severe valvular insuffi ciency, which may lead to intractable congestive heart failure and myocardialabscesses. This disease still carries a poor prognosis and a high mortality.A severe case of infective endocarditis with its complications is presented. A man with aortic prosthetic valve due to earlier aortic stenosis and corrected aortal coarctation and implanted pacemaker presentedwith prolonged unexplained fever, malaise, sweating, weight loss (15 kg/4 months) and lumbar pain. He was treated with broad-spectrum antibiotics prior IE diagnosis was considered. Echocardiogram showedaortic vegetations and possible periaortal abscess formation. Nonspecifi c infl ammation parameters were high positive. Cultures were constantly negative. His condition had deteriorated suddenly, and he had presentedwith worsening of cutaneous vasculitis, subacute glomerulonephritis and subsequent acute respiratory distress syndrome and septic shock. This patient survived with residual bilateral necrosis of the feet andtoxic peroneal paresis. At the end transthoracic echocardiogram showed enlarged heart chambers, LV mild dilated and concentric hypertrophy with ejection fraction about 40%, degenerative postinfl ammatory mitralvalve changes, mild mitral regurgitation and tricuspid regurgitation, postinfl ammatory aortic root fi brosis and moderate aortic valve stenosis (AVPG max 50,9 mmHg, AVPG mean 24 mmHg) with no pericardial effusion. Initial suspicion of Q fever was defi nitely excluded by serological testing showing nonspecifi c IgM positivity,probably rheumatoid factor related.