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A Case Report of Fever and Severe Anemia Caused by Repeated Epistaxis

Received: 18 March 2022     Published: 23 March 2022
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Abstract

Objective: To explore the potential pathogenicity of epistaxis in routine diagnosis and treatment. Methods: The data of a patient with recurrent epistaxis and fever for more than 5 months were observed. Li Mou, a 21-year-old male patient complained epistaxis after digging his nose and was relieved after self-packing treatment before May. Due to the habit of blowing nose, digging his nose and staying up late in nights for playing games, he did not paid attention to his recurrent epistaxis 3 ~ 5 times a month. He had fever in January and his blood routine examination showed mild anemia. Autoimmune hemolytic anemia was considered after screening for blood system disorders. There was no remission after shock treatment with prednisone tablets, and the degree of anemia increased gradually. Frequent epistaxis did not improve after repeated nasal endoscopy, tamponade, cauterization and other treatment. He was admitted to hospital with severe anemia. After admission, the patient was examined for anemia, pale eyelid and conjunctiva, and it was fixed with oil gauze in both nasal cavities. A systolic murmur was heard in the apical region and the second auscultation area of aortic valve; the respiratory sounds of both lungs were rough, and there were no dry and wet rales. The abdomen was soft, without tenderness, rebound pain and muscle tension; there was no edema in both lower limbs. Two independent blood cultures were examined after admission, which showed defective hypoxic bacteria. Cardiac color Doppler ultrasound showed valve vegetations, perforation and reflux. Diagnosis of infective endocarditis caused by defective hypoxic bacteria was made after examination. Antibiotics combined with valve replacement surgery were performed for the treatment. Results: After one year follow-up, the symptoms of anemia and epistaxis were reveled. Conclusion: Routine diagnosis and treatment of epistaxis may be a potential risk factor for infective endocarditis; the presence of infective endocarditis and bacteremia may increase the frequency of epistaxis, resulting in multiple visits to hospital for treatment of epistaxis; in the diagnosis and treatment of autoimmune hemolytic anemia, it is necessary to screen infective endocarditis to rule out the adequate diagnosis.

Published in Science Discovery (Volume 10, Issue 2)
DOI 10.11648/j.sd.20221002.11
Page(s) 25-28
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2022. Published by Science Publishing Group

Keywords

Epistaxis, Endocarditis, Bacterial, Hemolytic Anemia, Autoimmune, Oxygen Deficient Bacteria

References
[1] 中华医学会血液学分会红细胞疾病(贫血)学组。自身免疫性溶血性贫血诊断与治疗中国专家共识(2017年版)[J]。中华血液学杂志,2017,38(4):265-267。
[2] 中华医学会心血管病学分会,中华心血管病杂志编辑委员会。成人感染性心内膜炎预防、诊断和治疗专家共识[J]。中华心血管病杂志,2014,42(10):806-816。
[3] Gould FK, Denning DW, Elliott TS, et al. Guidelines for the diagnosis and antibiotic treatment of endocarditis in adults: a report of the Working Party of the British Society for Antimicrobial Chemotherapy [published correction appears in J Antimicrob Chemother. 2012 May; 67 (5): 1304]. J Antimicrob Chemother. 2012; 67 (2): 269-289.
[4] Kuroyanagi T, Kura K, Akamatsu Y, Arao T. A case report of the immunodysplasia syndrome and heavy chain disease associated with subacute bacterial endocarditis. Tohoku J Exp Med. 1979; 128 (4): 325-331.
[5] Williams JM, Parimi M, Sutherell J. Bartonella endocarditis in a child with tetralogy of Fallot complicated by PR3-ANCA positive serology, autoimmune hemolytic anemia, and acute kidney injury. Clin Case Rep. 2018; 6 (7): 1264-1267.
[6] 张雪晗,焦洋。第481例发热—乏力—重度贫血[J]。中华医学杂志,2019,99(41):3273-3276。
[7] Ruan W, Yap P, Foo SS, Lee KK, Low JA, Yap KB. An unusual case of epistaxis and Staphylococcus aureus bacteremia in an older chinese woman. J Am Geriatr Soc. 2010; 58 (9): 1815-1816.
[8] Koehler P, Jung N, Kochanek M, Lohneis P, Shimabukuro-Vornhagen A, Böll B. 'Lost in Nasal Space': Staphylococcus aureus sepsis associated with Nasal Handkerchief Packing. Infection. 2019; 47 (2): 307-311.
[9] Yerebakan C, Westphal B, Skrabal C, et al. Aortic valve endocarditis due to biotrophia defectiva: a rare etiology. Wien Med Wochenschr. 2008; 158 (5-6): 152-155.
[10] Kawamura Y, Hou XG, Sultana F, Liu S, Yamamoto H, Ezaki T. Transfer of Streptococcus adjacens and Streptococcus defectivus to Abiotrophia gen. nov. as Abiotrophia adiacens comb. nov. and Abiotrophia defectiva comb. nov., respectively. Int J Syst Bacteriol. 1995; 45 (4): 798-803.
[11] 中华耳鼻咽喉头颈外科杂志编辑委员会鼻科组,中华医学会耳鼻咽喉头颈外科学分会鼻科学组。鼻出血诊断及治疗指南(草案)[J]。中华耳鼻咽喉头颈外科杂志,2015,50(4):265-267。
[12] 刘懿霆,沙骥超,朱冬冬等。英国鼻科学会鼻出血多学科治疗指南及共识解读[J]。临床耳鼻咽喉头颈外科杂志,2019,33(11):1022-1026。
[13] 钱方毅。重视心力衰竭发病机制中的神经内分泌细胞因子系统的研究[J]。中国循环杂志,2001,16(4):243-245.
[14] Lubianca Neto JF, Fuchs FD, Facco SR, et al. Is epistaxis evidence of end-organ damage in patients with hypertension?. Laryngoscope. 1999; 109 (7 Pt 1): 1111-1115.
[15] Liu C, Bhushan S, Mao L, et al. The Infective Endocarditis with Recurrent Epistaxis in a Young Patient: A Case Report. Heart Surg Forum. 2021; 24 (2): E317-E319.
Cite This Article
  • APA Style

    Liu Chunguang, Bhushan Sandeep, Zhao Danxu, Shi Yun, Tu Yuan, et al. (2022). A Case Report of Fever and Severe Anemia Caused by Repeated Epistaxis. Science Discovery, 10(2), 25-28. https://doi.org/10.11648/j.sd.20221002.11

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    ACS Style

    Liu Chunguang; Bhushan Sandeep; Zhao Danxu; Shi Yun; Tu Yuan, et al. A Case Report of Fever and Severe Anemia Caused by Repeated Epistaxis. Sci. Discov. 2022, 10(2), 25-28. doi: 10.11648/j.sd.20221002.11

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    AMA Style

    Liu Chunguang, Bhushan Sandeep, Zhao Danxu, Shi Yun, Tu Yuan, et al. A Case Report of Fever and Severe Anemia Caused by Repeated Epistaxis. Sci Discov. 2022;10(2):25-28. doi: 10.11648/j.sd.20221002.11

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  • @article{10.11648/j.sd.20221002.11,
      author = {Liu Chunguang and Bhushan Sandeep and Zhao Danxu and Shi Yun and Tu Yuan and Xu Xuejun and Xiao Zongwei},
      title = {A Case Report of Fever and Severe Anemia Caused by Repeated Epistaxis},
      journal = {Science Discovery},
      volume = {10},
      number = {2},
      pages = {25-28},
      doi = {10.11648/j.sd.20221002.11},
      url = {https://doi.org/10.11648/j.sd.20221002.11},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.sd.20221002.11},
      abstract = {Objective: To explore the potential pathogenicity of epistaxis in routine diagnosis and treatment. Methods: The data of a patient with recurrent epistaxis and fever for more than 5 months were observed. Li Mou, a 21-year-old male patient complained epistaxis after digging his nose and was relieved after self-packing treatment before May. Due to the habit of blowing nose, digging his nose and staying up late in nights for playing games, he did not paid attention to his recurrent epistaxis 3 ~ 5 times a month. He had fever in January and his blood routine examination showed mild anemia. Autoimmune hemolytic anemia was considered after screening for blood system disorders. There was no remission after shock treatment with prednisone tablets, and the degree of anemia increased gradually. Frequent epistaxis did not improve after repeated nasal endoscopy, tamponade, cauterization and other treatment. He was admitted to hospital with severe anemia. After admission, the patient was examined for anemia, pale eyelid and conjunctiva, and it was fixed with oil gauze in both nasal cavities. A systolic murmur was heard in the apical region and the second auscultation area of aortic valve; the respiratory sounds of both lungs were rough, and there were no dry and wet rales. The abdomen was soft, without tenderness, rebound pain and muscle tension; there was no edema in both lower limbs. Two independent blood cultures were examined after admission, which showed defective hypoxic bacteria. Cardiac color Doppler ultrasound showed valve vegetations, perforation and reflux. Diagnosis of infective endocarditis caused by defective hypoxic bacteria was made after examination. Antibiotics combined with valve replacement surgery were performed for the treatment. Results: After one year follow-up, the symptoms of anemia and epistaxis were reveled. Conclusion: Routine diagnosis and treatment of epistaxis may be a potential risk factor for infective endocarditis; the presence of infective endocarditis and bacteremia may increase the frequency of epistaxis, resulting in multiple visits to hospital for treatment of epistaxis; in the diagnosis and treatment of autoimmune hemolytic anemia, it is necessary to screen infective endocarditis to rule out the adequate diagnosis.},
     year = {2022}
    }
    

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  • TY  - JOUR
    T1  - A Case Report of Fever and Severe Anemia Caused by Repeated Epistaxis
    AU  - Liu Chunguang
    AU  - Bhushan Sandeep
    AU  - Zhao Danxu
    AU  - Shi Yun
    AU  - Tu Yuan
    AU  - Xu Xuejun
    AU  - Xiao Zongwei
    Y1  - 2022/03/23
    PY  - 2022
    N1  - https://doi.org/10.11648/j.sd.20221002.11
    DO  - 10.11648/j.sd.20221002.11
    T2  - Science Discovery
    JF  - Science Discovery
    JO  - Science Discovery
    SP  - 25
    EP  - 28
    PB  - Science Publishing Group
    SN  - 2331-0650
    UR  - https://doi.org/10.11648/j.sd.20221002.11
    AB  - Objective: To explore the potential pathogenicity of epistaxis in routine diagnosis and treatment. Methods: The data of a patient with recurrent epistaxis and fever for more than 5 months were observed. Li Mou, a 21-year-old male patient complained epistaxis after digging his nose and was relieved after self-packing treatment before May. Due to the habit of blowing nose, digging his nose and staying up late in nights for playing games, he did not paid attention to his recurrent epistaxis 3 ~ 5 times a month. He had fever in January and his blood routine examination showed mild anemia. Autoimmune hemolytic anemia was considered after screening for blood system disorders. There was no remission after shock treatment with prednisone tablets, and the degree of anemia increased gradually. Frequent epistaxis did not improve after repeated nasal endoscopy, tamponade, cauterization and other treatment. He was admitted to hospital with severe anemia. After admission, the patient was examined for anemia, pale eyelid and conjunctiva, and it was fixed with oil gauze in both nasal cavities. A systolic murmur was heard in the apical region and the second auscultation area of aortic valve; the respiratory sounds of both lungs were rough, and there were no dry and wet rales. The abdomen was soft, without tenderness, rebound pain and muscle tension; there was no edema in both lower limbs. Two independent blood cultures were examined after admission, which showed defective hypoxic bacteria. Cardiac color Doppler ultrasound showed valve vegetations, perforation and reflux. Diagnosis of infective endocarditis caused by defective hypoxic bacteria was made after examination. Antibiotics combined with valve replacement surgery were performed for the treatment. Results: After one year follow-up, the symptoms of anemia and epistaxis were reveled. Conclusion: Routine diagnosis and treatment of epistaxis may be a potential risk factor for infective endocarditis; the presence of infective endocarditis and bacteremia may increase the frequency of epistaxis, resulting in multiple visits to hospital for treatment of epistaxis; in the diagnosis and treatment of autoimmune hemolytic anemia, it is necessary to screen infective endocarditis to rule out the adequate diagnosis.
    VL  - 10
    IS  - 2
    ER  - 

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Author Information
  • First Clinical College, Zunyi Medical University, Zunyi, China

  • Department of Cardiothoracic Surgery, Chengdu Second People's Hospital, Chengdu, China

  • First Clinical College, Zunyi Medical University, Zunyi, China

  • Department of Ultrasound, Chengdu Second People's Hospital, Chengdu, China

  • Department of Pathology, Chengdu Second People's Hospital, Chengdu, China

  • Department of Neurosurgery, Chengdu Second People's Hospital, Chengdu, China

  • Department of Cardiothoracic Surgery, Chengdu Second People's Hospital, Chengdu, China

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