Successful management of a complicated clinical crisis

Rationale: Hemophagocytic lymphohistiocytosis (HLH) secondary to methicillin-resistant Staphylococcus epidermidis (MRSE)related left-sided infectious endocarditis had never been reported before. In the last decade, daptomycin, a novel lipopeptide antibiotic, showed its excellent role in anti-Gram-positive bacteria, including soft tissue infection, bloodstream and deep tissueinfection. Patientconcerns:An Asian women under sever condition due to the cooccurrence of HLH andMRSE-related endocarditis while also be allergic to vancomycin. The patient was cured by high-dose daptomycin monotheraphy, HLH-2004 protocol and cardiothoracic surgery to remove the valve at last, and was obviously benefit from the endeavor of a multidisciplinary team (MDT) strategy. Diagnoses: IE was made on March 27according to the modified Duke criteria. HLH was diagnosed too. Interventions:The patient was cured by high-dose daptomycinmonotheraphy, HLH-2004 protocol and cardiothoracic surgery to remove the valve at last, and was obviously benefit from the endeavor of a multidisciplinary team (MDT) strategy. Outcomes: The patient was healthy andstable when we published this case. Lessons:This case proves high-dose daptomycin monotheraphy could be used as an effective alternative regimen for vancomycin in treating MRSE-related left-sided endocarditis and highlight the importance of early diagnosis and appropriate management for HLH. Furthermore, our work suggests an MDT model as a practical strategy in managing similar clinical situation. Abbreviations: CBC = complete blood count, HLH = hemophagocytic lymphohistiocytosis, HPS = hemophagocytic syndrome, IE = infectious endocarditis, MDT = multidisciplinary team, MRSE = methicillin-resistant Staphylococcus epidermidis.