Staphylococcus-induced proliferative glomerulonephritis and cerebral hemorrhage – fatal complications in a young female with postpartum cardiomyopathy and an implanted left ventricular assist device: a case report and review of the literature

Abstract

Background: The continuous-flow left ventricular assist device (CF-LVAD) is used to save the lives of patients in the final stage of congestive heart failure, replacing the pump function of the left ventricle. Although quality of life increases significantly, CF-LVAD-related complications might prove fatal, as in the case presented in this paper.

Methods: A 20-year-old female, during her second pregnancy, presented with signs of heart failure. Emergency caesarean section was necessary to save the baby, but peripartum cardiomyopathy developed in the mother. The use of an implantable cardioverter-defibrillator (ICD) was necessary 5 years later. As the clinical progression was unfavorable under medical treatment, with the patient reaching INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) Profile 1 (refractory cardiogenic shock), the treatment of choice was the implantation of a CF-LVAD.

Results: After 3 years of follow-up (at the age of 28), the patient presented with a positive hemoculture for Staphylococcus aureus. Prolonged antibiotic therapy and attentive follow-up was prescribed. Although an effective antiplatelet and anticoagulant treatment was applied, and despite therapeutic values of prothrombin time and international normalized ratio (INR), the patient died as result of a fatal cerebral hemorrhage. The autopsy also revealed septic emboli, disseminated intravascular coagulation, and focal proliferative glomerulonephritis.

Conclusions: Although the benefits of CF-LVAD are significant, bleeding episodes can be severe and LVAD-associated infection can trigger glomerular injury and increase mortality.

Keywords:

• Ventricular assist device
• hemorrhage
• stroke
• brain
• peripartum
• cardiomyopathy
• glomerulonephritis

Acknowledgements

The authors give thanks to colleagues involved in the long-term management of this case. Cambridge Proofreading LLC team did the English proofread.

Ethical approval

Signed informed consent for publication of data was obtained during hospitalization. The approval of the Director of Institute for Cardio-Vascular Diseases and Transplantation of Clinical County Emergency Hospital of Targu Mures, Romania, was obtained for clinical data revision.

Author contributions

OCE performed the clinical investigations, as a cardiologist, and drafted the manuscript; SH performed the surgical and clinical management of the case; BL and BCM performed the autopsy and managed the postmortem diagnosis; OCE and HM contributed to the clinical and surgical assessment, reviewed the literature, and manuscript drafting; IM contributed to the clinical investigations as a cardiologist and managed the paraclinical examinations; GS assisted in the autopsy, developed the study design, and authorized the final version of the paper. All authors approved the final version of the paper. OCE and BCM have equal contributions to the paper.

Disclosure statement

No potential conflict of interest was reported by the author(s).