ACQUIRED ARTERIOVENOUS FISTULA WITH SUBACUTE BACTERIAL ENDOCARDITIS AND ENDARTERITIS

Abstract

Acquired arteriovenous fistulas resulting from stab and gunshot wounds, with coexistent subacute septicemia due to Streptococcus viridans are not common. Hamman and Rienhoff¹and Touroff and co-workers²described the first two patients cured of the septicemia following excision of the infected arteriovenous fistula. Four similar cases with cures following surgery have since been reported.³ Bretschneider,⁴Walz,⁵Gravier,⁶Leaman,⁷Porter and Williams,⁸and Cutler and Wolf,⁹reported cases in which the infection did not remain localized to the fistula and in which there was associated subacute bacterial endocarditis. The futility of excising the fistula in such cases has been recognized; however, the use of antibiotics and chemotherapeutic agents offers a possible cure that previously did not exist. Unfortunately, in the report that follows, the patient died, despite penicillin therapy and surgical excision of the fistula. To our knowledge, this is the first