Infective endocarditis - why should rheumatologists be aware?

Area of Science:

• Cardiology
• Rheumatology
• Infectious Diseases

Background:

• Infective endocarditis (IE) presents diverse clinical manifestations, often complicating diagnosis.
• Musculoskeletal symptoms are common in IE but frequently overlooked, delaying critical treatment.
• Rheumatic heart disease necessitates careful monitoring for potential complications like IE.

Observation:

• A 44-year-old female with a history of rheumatic valve disease presented with migratory polyarthritis and painful skin lesions.
• Clinical findings included Osler's nodes and spleen infarcts, raising suspicion for IE.
• Blood cultures identified a HACEK group microorganism, confirming the diagnosis.

Findings:

• The patient was diagnosed with subacute infective endocarditis based on clinical presentation, imaging, and microbiology.
• Differential diagnoses were systematically excluded to confirm IE.
• Intravenous antibiotic therapy led to complete clinical resolution.

Implications:

• This case highlights the diagnostic challenges posed by atypical IE presentations, particularly musculoskeletal manifestations.
• Emphasizes the critical role of a multidisciplinary approach involving rheumatology and cardiology in diagnosing IE.
• Underscores the importance of considering IE in patients with unexplained migratory arthralgias and relevant risk factors.