SUMMARYInfective endocarditis (IE) may present with rheumatological manifestations such as myalgias, arthralgias, arthritis and back pain. However, muscle inflammation is rare. We present a case of a 68-year-old Hispanic man who presented with 1-month history of tiredness, weight loss, fever, myalgias, muscle weakness and dysphagia to solid food. On physical examination he had severe weakness in the proximal upper and lower extremities, and erythematous eruption involving the upper eyelids, neck and metacarpophalangeal joints. Creatine kinase levels were markedly elevated at 15 809 U/L. MRI of the right thigh revealed intermuscular and intramuscular oedema. Muscle biopsy showed acute necrotising suppurative perimyositis. Blood cultures were positive for methicillin-resistant Staphylococcus aureus. A transoesophageal echocardiogram revealed vegetations in the pulmonic valve. All clinical manifestations were resolved completely with broad-spectrum antibiotics. This case suggests that IE should be considered in the differential diagnosis of a patient presenting with inflammatory myopathy. BACKGROUND
Takayasu arteritis (TA) is a large-vessel vasculitis characterised by stenosis, dilation and/or aneurysm formation. We present a case of a 43-year-old man with an initial manifestation of an acute thrombosed aneurysm. He was found to have a thrombosed right common femoral artery aneurysm on Doppler ultrasound. Physical examinations revealed a substantial difference in blood pressure level between bilateral upper extremities, and absent pulses at right upper and lower extremities. The diagnosis was confirmed by angiography, which revealed 100% occlusion of the right common femoral artery. Biopsy of the thrombosed aneurysm was consistent with a diffuse lymphocytic subendothelial infiltrate. The patient was treated with high-dose corticosteroids and had a good response to treatment, as demonstrated by a decrease in sedimentation rate, and recovery of the right side pulses. This case helps to create awareness among physicians that TA may present with an acute occlusion of an aneurysm without the typical warning symptoms of TA.
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