Fever of unknown origin – a needle in a haystack

    Authors

    Keywords

    needle, foreign body, fever of unknown origin

    DOI

    https://doi.org/10.15836/ccar2016.526

    Full Text

    **Introduction:** Fever of unknown origin (FUO) is a challenging clinical syndrome which encompasses wide clinical scenarios and requires bright decision making. (1-3) **Case presentation:** We present a case of a 53-year-old man who was hospitalized because of intermittent fever that lasted for two years. He underwent a huge specter of diagnostic procedures that excluded infectious, immunological, hematological and tumorous causes of a long lasting fever. Due to advanced cardiac imaging a suspected foreign body in the heart was visualized. Computed imaging, transthoracic echocardiography and cardiac catheterization revealed one linear metallic density that corresponds to a sewing needle localized in the right ventricular outflow tract (RVOT). Right ventricle was mildly dilated (3cm) and systolic function was slightly reduced (40%). After all examinations patient was presented to a cardiothoracic surgeon for a surgical removal of the needle. Even after psychiatric consultation it remained unknown whether the strange body in the heart was consequence of self-mutilation or an accidental event. **Conclusion:** A needle in the heart is a comparatively rare event. It has been described in cases of self-mutilation in psychiatric patients, intravenous injection and puncturing with acupuncture needles. Surgical removal of a sewing needle is the treatment of choice, but psychiatric consultation is recommended.

    Literature

    1. Kim KH, Ahn H. Intracardiac foreign body: a sewing needle in the right ventricle. Eur J Cardiothorac Surg. 2001;19:513. https://doi.org/10.1016/S1010-7940(01)00629-7
    2. Mandegar MH, Ali Yousefnia M, Rayatzadeh H, Roshanali F. Intramyocardial sewing needle extracted one year after insertion. Interact Cardiovasc Thorac Surg. 2006;5(6):742–3. https://doi.org/10.1510/icvts.2006.138784
    3. Sarmento-Leite R, Silva GV, Goulart LC, Gottschall CA, Perin EC. A sewing needle in the right ventricle. Tex Heart Inst J. 2000;27(3):314–5. https://pubmed.ncbi.nlm.nih.gov/11093424/
    Cardiologia Croatica
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    Fever of unknown origin – a needle in a haystack

    Extended Abstract
    Issue10-11
    Published
    Pages526
    PDF via DOIhttps://doi.org/10.15836/ccar2016.526
    needle
    foreign body
    fever of unknown origin

    Authors

    Ana Jordan*ORCIDUniversity Hospital Dubrava, Zagreb, Croatia
    Mario SičajaORCIDUniversity Hospital Dubrava, Zagreb, Croatia
    Boris StarčevićORCIDUniversity Hospital Dubrava, Zagreb, Croatia

    *Correspondence email: anazovko4@gmail.com

    Full Text

    Introduction: Fever of unknown origin (FUO) is a challenging clinical syndrome which encompasses wide clinical scenarios and requires bright decision making. (1–3)

    Case presentation: We present a case of a 53-year-old man who was hospitalized because of intermittent fever that lasted for two years. He underwent a huge specter of diagnostic procedures that excluded infectious, immunological, hematological and tumorous causes of a long lasting fever. Due to advanced cardiac imaging a suspected foreign body in the heart was visualized. Computed imaging, transthoracic echocardiography and cardiac catheterization revealed one linear metallic density that corresponds to a sewing needle localized in the right ventricular outflow tract (RVOT). Right ventricle was mildly dilated (3cm) and systolic function was slightly reduced (40%). After all examinations patient was presented to a cardiothoracic surgeon for a surgical removal of the needle. Even after psychiatric consultation it remained unknown whether the strange body in the heart was consequence of self-mutilation or an accidental event.

    Conclusion: A needle in the heart is a comparatively rare event. It has been described in cases of self-mutilation in psychiatric patients, intravenous injection and puncturing with acupuncture needles. Surgical removal of a sewing needle is the treatment of choice, but psychiatric consultation is recommended.

    Literature

    1. 1.
      Kim KH, Ahn H. Intracardiac foreign body: a sewing needle in the right ventricle. Eur J Cardiothorac Surg. 2001;19:513.DOI
    2. 2.
      Mandegar MH, Ali Yousefnia M, Rayatzadeh H, Roshanali F. Intramyocardial sewing needle extracted one year after insertion. Interact Cardiovasc Thorac Surg. 2006;5(6):742–3.DOI
    3. 3.
      Sarmento-Leite R, Silva GV, Goulart LC, Gottschall CA, Perin EC. A sewing needle in the right ventricle. Tex Heart Inst J. 2000;27(3):314–5.PubMed