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Infective Endocarditis Masquerading as Rheumatoid Arthritis

Infective endocarditis (IE) is associated with high inflammatory markers including rheumatoid factor (RF). Diagnosis can be difficult when it presents with musculoskeletal symptoms, and a raised RF titer as it points towards an autoimmune joint disease. It is imperative to rule out IE by echocardiog...

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Autores principales: Peechakara, Basil, Kadam, Amey, Mewada, Megha, Nakrani, Akshay
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6822880/
https://www.ncbi.nlm.nih.gov/pubmed/31700729
http://dx.doi.org/10.7759/cureus.5626
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author Peechakara, Basil
Kadam, Amey
Mewada, Megha
Nakrani, Akshay
author_facet Peechakara, Basil
Kadam, Amey
Mewada, Megha
Nakrani, Akshay
author_sort Peechakara, Basil
collection PubMed
description Infective endocarditis (IE) is associated with high inflammatory markers including rheumatoid factor (RF). Diagnosis can be difficult when it presents with musculoskeletal symptoms, and a raised RF titer as it points towards an autoimmune joint disease. It is imperative to rule out IE by echocardiography and blood cultures. A 42-year-old male with type two diabetes mellitus presented to our hospital with severe back pain, hemoptysis, mild pain in multiple joints, and low-grade fever for three months. He was previously seen by a rheumatologist and was clinically diagnosed with rheumatoid arthritis along with a RF level of 505.3 IU/mL. After an extensive investigation, transthoracic echocardiography (TTE) showed vegetations on the ventricular side of the aortic valve. Transesophageal echocardiography (TEE) confirmed vegetations on the aortic valve and also detected anterior mitral valve leaflet perforation with regurgitation. He was treated with ceftriaxone and gentamycin for six and two weeks, respectively. High RF is associated with IE possibly due to an intense immune response generated by a chronic intravascular infection. Echocardiography should be performed in a suspected case as a prompt diagnosis is related to better outcomes.
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spelling pubmed-68228802019-11-07 Infective Endocarditis Masquerading as Rheumatoid Arthritis Peechakara, Basil Kadam, Amey Mewada, Megha Nakrani, Akshay Cureus Cardiology Infective endocarditis (IE) is associated with high inflammatory markers including rheumatoid factor (RF). Diagnosis can be difficult when it presents with musculoskeletal symptoms, and a raised RF titer as it points towards an autoimmune joint disease. It is imperative to rule out IE by echocardiography and blood cultures. A 42-year-old male with type two diabetes mellitus presented to our hospital with severe back pain, hemoptysis, mild pain in multiple joints, and low-grade fever for three months. He was previously seen by a rheumatologist and was clinically diagnosed with rheumatoid arthritis along with a RF level of 505.3 IU/mL. After an extensive investigation, transthoracic echocardiography (TTE) showed vegetations on the ventricular side of the aortic valve. Transesophageal echocardiography (TEE) confirmed vegetations on the aortic valve and also detected anterior mitral valve leaflet perforation with regurgitation. He was treated with ceftriaxone and gentamycin for six and two weeks, respectively. High RF is associated with IE possibly due to an intense immune response generated by a chronic intravascular infection. Echocardiography should be performed in a suspected case as a prompt diagnosis is related to better outcomes. Cureus 2019-09-11 /pmc/articles/PMC6822880/ /pubmed/31700729 http://dx.doi.org/10.7759/cureus.5626 Text en Copyright © 2019, Peechakara et al. http://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Cardiology
Peechakara, Basil
Kadam, Amey
Mewada, Megha
Nakrani, Akshay
Infective Endocarditis Masquerading as Rheumatoid Arthritis
title Infective Endocarditis Masquerading as Rheumatoid Arthritis
title_full Infective Endocarditis Masquerading as Rheumatoid Arthritis
title_fullStr Infective Endocarditis Masquerading as Rheumatoid Arthritis
title_full_unstemmed Infective Endocarditis Masquerading as Rheumatoid Arthritis
title_short Infective Endocarditis Masquerading as Rheumatoid Arthritis
title_sort infective endocarditis masquerading as rheumatoid arthritis
topic Cardiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6822880/
https://www.ncbi.nlm.nih.gov/pubmed/31700729
http://dx.doi.org/10.7759/cureus.5626
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