Fusobacterium nucleatum endocarditis mimicking polymyalgia rheumatica

Area of Science:

• Infectious Diseases
• Rheumatology
• Cardiology

Background:

• Subacute infective endocarditis often presents insidiously, particularly with low-virulence organisms.
• Fusobacterium nucleatum is an uncommon cause of endocarditis, often associated with poor oral hygiene.
• Polymyalgia rheumatica is a common condition in the elderly, characterized by musculoskeletal pain and stiffness.

Observation:

• An 80-year-old male presented with headache and nonspecific musculoskeletal symptoms, initially diagnosed as polymyalgia rheumatica.
• The patient's symptoms were unresponsive to prolonged corticosteroid therapy.
• Despite the initial misdiagnosis, the patient eventually developed symptoms suggestive of bacterial endocarditis.

Findings:

• The patient was diagnosed with Fusobacterium nucleatum endocarditis.
• Intravenous ampicillin treatment led to complete resolution of the musculoskeletal and rheumatologic symptoms.
• This case highlights the diagnostic challenge posed by atypical presentations of endocarditis.

Implications:

• Rheumatologic symptoms, such as those seen in polymyalgia rheumatica, can mask or mimic subacute infective endocarditis.
• Physicians should consider bacterial endocarditis in elderly patients with atypical or unresponsive rheumatic symptoms.
• Early recognition and appropriate antibiotic therapy are crucial for favorable outcomes in infective endocarditis.