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Bacterial endocarditis and septic arthritis presenting as polymyalgia rheumatica
Rhode Island Medicine
|January 1, 1994
Summary
Enterococcus endocarditis can mimic rheumatic conditions like polymyalgia rheumatica. Prompt diagnosis and antibiotic treatment resolved severe musculoskeletal symptoms in this case.
Area of Science:
- Infectious Diseases
- Rheumatology
- Cardiology
Background:
- Bacterial endocarditis, an infection of the heart lining or valves, can present with diverse clinical manifestations.
- Musculoskeletal symptoms are frequently reported in endocarditis but can be non-specific, leading to diagnostic challenges.
Observation:
- A 74-year-old woman with a history of hypercholesterolemia, a porcine aortic valve, and osteoarthritis presented with acute back pain, myalgia, and synovitis.
- Initial presentation suggested polymyalgia rheumatica, supported by anemia and elevated erythrocyte sedimentation rate (ESR).
Findings:
- Diagnosis was revised to enterococcus endocarditis upon positive blood and synovial fluid cultures.
- Septic arthritis, though rare, was the presenting manifestation of endocarditis in this patient.
- Complete resolution of musculoskeletal symptoms was achieved with appropriate antibiotic therapy.
Implications:
- Unexplained rheumatic symptoms, including myalgia and arthritis, should raise suspicion for infective endocarditis.
- Early recognition of endocarditis is crucial to prevent severe complications and ensure effective treatment.
- This case highlights the importance of considering infectious etiologies in patients with new-onset rheumatic complaints.