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Vasculitis masquerading as aortic valve endocarditis.

M B Iqbal1, N G Fisher, K M Fox

  • 1Department of Cardiology, Level 3, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK. biqbal@excite.com

Heart (British Cardiac Society)
|April 16, 2005
PubMed
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Small vessel vasculitis can mimic endocarditis, presenting with multisystem symptoms, renal dysfunction, and heart block. Differentiating these conditions is crucial, as immunosuppression is life-saving for vasculitis but dangerous for endocarditis.

Area of Science:

  • Nephrology
  • Cardiology
  • Rheumatology

Background:

  • Small vessel vasculitis and endocarditis can present with overlapping multisystem symptoms, posing diagnostic challenges.
  • Renal and cardiac involvement are common in small vessel vasculitis, with heart block being a rare but significant manifestation.
  • Distinguishing between these conditions is critical due to vastly different treatment implications.

Observation:

  • A patient with a history of aortic valve endocarditis presented with recurrent diffuse symptoms, worsening renal function, and heart block.
  • Initial investigations ruled out active aortic valve endocarditis with abscess.
  • Renal biopsy confirmed the presence of small vessel vasculitis.

Findings:

  • The patient's symptoms and renal deterioration were attributed to small vessel vasculitis.

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  • Prompt initiation of immunosuppressive therapy led to a significant clinical improvement.
  • The diagnosis of small vessel vasculitis prevented unnecessary and potentially harmful aortic valve surgery.

    • Implications:

    • Accurate diagnosis is paramount in cases of multisystem disease with renal and cardiac involvement.
    • Immunosuppression is a life-saving treatment for small vessel vasculitis but contraindicated in active endocarditis.
    • This case highlights the importance of considering small vessel vasculitis in the differential diagnosis of heart block and renal failure, especially in patients with prior endocarditis.