64 y/o PMHx of HTN, BPH, Rt knee meniscus tear, depression
no medical or surgical history listed and not on any medications.
Client has an untreated dental abscess for months. He knew about the abscess and didn’t obtain medical care until 9/23/24 when he presented to an Urgent Care with joint pain and fatigue. APRN put him on Amoxicillin x 10 days & blood work ordered (appropriate). Notes indicate 1 week follow-up-generalized joint pain and fatigue. Concern for Lyme -screening completed at last visit negative. No fever, chills or other symptoms, no facial or sinus pain. PE: Oral Cavity: Teeth: Dental abnormalities. Abscess in a tooth right upper. RX Amoxicillin 875 MG tablet one po bid, 10 days. Return in 2 weeks for lab results.
On 10/7/24, client returns to Urgent Care for lab results, and he has an elevated CRP & sed rate with ongoing fatigue. Afebrile. No c/o tooth pain. Potential breach: ARNP refers him to rheumatology but likely should have considered systemic infection/endocarditis & sent him to ED or ordered additional labs.
On 10/25/24, EMS called for left flank pain & taken to Hospital. Admitted. WBC 12.3, initial imaging showed splenic infarct, mild hydronephrosis, blood cx positive for strep mitis/oralis. IV abx. TEE done showing possible aortic valve vegetation. Dental extractions. done. AVR/MVR on 11/5 for VALVE vegetation.
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