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[A classic example of infectious endocarditis?]

M R van der Schaaf¹, P W Westerhof

¹Academisch Ziekenhuis, afd. Cardiologie, Hart-Long Instituut, Utrecht.

Nederlands Tijdschrift Voor Geneeskunde

|May 1, 1998

Summary

A young girl initially diagnosed with infective endocarditis and requiring mitral valve replacement was later found to have systemic lupus erythematosus. Corticosteroid treatment resolved her symptoms, highlighting the importance of clinical presentation in diagnosis.

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Area of Science:

Cardiology
Rheumatology
Infectious Diseases

Background:

A 15-year-old female presented with symptoms suggestive of infective endocarditis, including fever, a new heart murmur, positive blood cultures, and mitral valve vegetations.
The patient was referred for mitral valve replacement due to suspected streptococcal endocarditis refractory to antibiotic treatment.

Observation:

Despite classic indicators of infective endocarditis, clinical doubt persisted regarding the diagnosis.
The patient's condition improved dramatically following a revised diagnosis of systemic lupus erythematosus and initiation of corticosteroid therapy.

Findings:

Systemic lupus erythematosus (SLE) can mimic infective endocarditis, presenting with overlapping clinical and echocardiographic findings.
Prompt diagnosis and appropriate treatment of SLE are crucial, even in the presence of seemingly clear signs of infection.

Implications:

This case underscores the critical role of thorough clinical evaluation and consideration of alternative diagnoses, even with seemingly definitive evidence.
It emphasizes that 'simple symptoms' remain vital in complex diagnostic scenarios, guiding clinicians toward accurate patient management.
The findings suggest a need for heightened awareness among clinicians regarding the potential for autoimmune diseases to present as severe infections.

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