A case of atopic dermatitis with infective endocarditis

A 34-year-old woman with atopic dermatitis was presented to our hospital with fever, visual field defect, purpura and hemorrhagic blisters on both palms and soles. We detected methicillin-sensitive Staphylococcus aureus (MSSA) by culturing blister fluid and circulating blood. Transthoracic echocardiography showed a growth on the mitral valve and mitral regurgitation, indicating a diagnosis of infective endocarditis. As she also suffered a cerebral infarction due to bacterial embolization, surgical intervention was undertaken to cure the infective endocarditis. Only 10 cases of atopic dermatitis with infective endocarditis have been reported in Japan. All of these patients had severe atopic dermatitis with Staphylococcus aureus infection. As Staphylococcus aureus is frequently found colonized on the skin surface of atopic dermatitis patients, it is likely that destruction of the skin barrier may cause sepsis leading to infective endocarditis. In order to avoid these serious complications, it is important to treat the atopic dermatitis appropriately according to standard therapeutic guideline.