A Stitch in Time

A CLINICAL PROBLEM-SOLVING article by Christopher Graber from University of California at San Francisco.
A 64-year-old man with a history of coronary artery disease and peripheral vascular disease with an aortobifemoral bypass seventeen months before was admitted with a several-month history of fevers, chills, and fatigue. These symptoms had begun soon after he had undergone percutaneous coronary intervention with placement of a stent in the left anterior descending coronary artery. He had initially been treated empirically with a 5-day course of ciprofloxacin. However, the symptoms returned 1 week after discontinuation of the antibiotic, and 3 weeks later he was admitted to a hospital. Blood cultures obtained at that time were positive for group C streptococcus. He was discharged with instructions to complete 6 weeks of therapy with ceftriaxone.
1 month after finishing the antibiotics, he reported the recurrence of fatigue, malaise, and low-grade fever.
At the outset of the case, the lack of blood cultures before the patient received antibiotic therapy on multiple occasions clouded the clinician's ability to make the diagnosis. However, the history of recurrent low-grade fevers and malaise despite antibiotic therapy and eventual multiple, positive blood cultures prompted a strong clinical suspicion of an endovascular infection.

タイトルは、A stitch in time saves nine.（転ばぬ先の杖）の諺から。