Arthritis and meningitis--the first manifestations of bacterial endocarditis in 2 patients

We have encountered 2 patients in whom the first manifestations of bacterial endocarditis were arthritis (in 1 case septic arthritis and in the other nonseptic arthritis) and bacterial meningitis. These presentations were followed by acute heart failure due to aortic valve destruction, although the patients showed no significant cardiovascular manifestations on admission. Aortic valve replacement was performed in each case and the patients' postoperative course was comfortable. We would like to emphasize the following points. (1) Arthritis and meningitis are uncommon in patients with bacterial endocarditis. However, it is necessary to consider the possibility of bacterial endocarditis when these clinical manifestations present together. Such a combination can cause rapid valve destruction. When more than 2 rare complications of bacterial endocarditis coexist, surgery should be considered as soon as the definite diagnosis of bacterial endocarditis is established, even if congestive heart failure has not yet developed. (2) Arthritis associated with bacterial endocarditis might be truly septic rather than mediated by circulating immune complexes as is commonly believed.