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Osteomyelitis and infective endocarditis
M E Speechly-Dick1, R H Swanton
1Department of Cardiology, Middlesex Hospital, London, UK.
Insights
Osteomyelitis can complicate infectious endocarditis, presenting similar symptoms. Early diagnosis is crucial; bone scans can help rule out osteomyelitis when radiography is inconclusive.
Area of Science:
- Infectious Diseases
- Orthopedic Surgery
- Cardiology
Background:
- Infectious endocarditis can lead to osteomyelitis in up to 6% of cases.
- Diagnosing osteomyelitis in endocarditis patients is challenging due to overlapping symptoms like fever and bone pain.
Observation:
- This study details the association of osteomyelitis with infectious endocarditis in three patients.
- Physicians require a high index of suspicion to identify this complication.
Findings:
- Plain radiographs may be normal or show minor abnormalities in early osteomyelitis.
- Bone scans are highly sensitive for detecting osteomyelitis and can effectively exclude the diagnosis if normal.
Implications:
- Investigate patients with endocarditis and persistent musculoskeletal symptoms for osteomyelitis.
- Prolonged antibiotic therapy (≥6 weeks IV, ≥3 months oral) is recommended.
- Early diagnosis and appropriate treatment are vital for managing this serious complication.
Abstract:
Osteomyelitis is thought to occur as a complication of infectious endocarditis in as many as 6% of cases of endocarditis. We describe this association in three patients. Osteomyelitis may be difficult to diagnose in patients with endocarditis because symptoms such as fever, bone pain and stiffness are common to both illnesses, therefore physicians need to have a high index of suspicion to avoid missing this important complication. We recommend that patients with endocarditis and persistent or localized musculoskeletal symptoms should be investigated to exclude osteomyelitis. Plain radiographs can be normal in 50% of cases of osteomyelitis in the early stages or show only minor abnormalities, but bone scans are highly sensitive. We suggest that a bone scan is performed if radiography is unhelpful, since a diagnosis of osteomyelitis can effectively be excluded if the bone scan is normal. We advocate close follow-up of these patients with prolonged antibiotic treatment consisting of at least 6 weeks of intravenous therapy, and 3 months or longer of oral therapy.