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Atypical infective endocarditis.

P R Gordon1, S A Allen

  • 1Department of Family and Community Medicine, University of Arizona College of Medicine, Tucson 85724, USA.

The Journal of the American Board of Family Practice
|October 26, 1999
PubMed
Summary
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Infective endocarditis can present atypically with back pain, mimicking pyelonephritis. This case highlights methicillin-resistant Staphylococcus aureus endocarditis complicated by an epidural abscess in an intravenous drug user.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Medical Case Reports

Background:

  • Infective endocarditis remains a significant clinical challenge despite evolving microbiologic and risk factors.
  • The condition involves septic platelet masses on heart valves, with diverse causative mechanisms.
  • Atypical presentations of infective endocarditis continue to pose diagnostic difficulties.

Observation:

  • A 42-year-old woman with a history of intravenous drug abuse presented with back pain and presumed pyelonephritis.
  • The patient subsequently developed hypoxia, a new heart murmur, and persistent fevers.
  • Initial symptoms mimicked a urinary tract infection, complicating early diagnosis.

Findings:

  • Blood cultures identified methicillin-resistant Staphylococcus aureus (MRSA) as the causative agent.

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  • Diagnostic imaging, including bone scan and MRI, revealed an epidural abscess.
  • The patient's presentation evolved from suspected pyelonephritis to infective endocarditis with a severe complication.

    • Implications:

    • This case underscores the importance of considering infective endocarditis in patients with unexplained back pain and systemic symptoms.
    • Early and accurate diagnosis is crucial for managing infective endocarditis and its potentially life-threatening complications like epidural abscess.
    • Intravenous drug abuse remains a critical risk factor for infective endocarditis, necessitating vigilant screening and management.