Infective endocarditis initially presenting with a dermatomyositis-like syndrome

Abstract

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

"Total laryngectomy with voice prosthesis – „gold standard“ treatment for patients with advanced laryngeal cancer"

“…This clinical and laboratory syndrome raised the suspicion of polymyositis, which had to be differentiated from RM in various pathological processes. Similar difficulties in the differential diagnosis were reported in one of the RM case descriptions upon SS in a patient with IE, successfully treated with antibiotics, followed by the disappearance of RM signs 14 . Muscle lesion was confirmed by autopsy and subsequent histological examination.…”

2015 ESC Guidelines for the management of infective endocarditis

“…IZW może komplikować lub być powikłane przez ropne zapalenie szpiku. Częstość występowania IZW w zapaleniu szpiku kręgów jest wyższa [288,289] w przypadku IZW spowodowanego przez Streptococcus viridans. U pacjentów z IZW, którzy skażą się na ból pleców lub bóle kostne, należy wykonać CT albo lepiej MRI kręgosłupa lub PET/CT całego ciała z zastosowaniem 18 F-FDG [290].…”

“…Inne objawy mięśniowo-szkieletowe występują w IZW rzadziej i obejmują zapalenie stawów krzyżowo-biodrowych w 1% przypadków, objawy naśladujące polimialgię reumatyczną z bólem i poranną sztywnością stawów barkowych oraz biodrowych, osłabieniem mięśni proksymalnych w 0,9% przypadków oraz leukocytoklastyczne zapalenie naczyń (zmiany skórne o charakterze plamicy) w 3,6% przypadków [282,289].…”

Fatal endocarditis with methicilin-sensible Staphylococcus aureus and major complications

“…[ 13 , 14 ] As far as we know, there are few published cases of rhabdomyolysis in patients with SA endocarditis and some of them presented similitudes with this case; in 2 cases, a child with severe myositis in a septic context and an adult with dermatomyositis-like syndrome, rhabdomyolysis (associated with cutaneous manifestations in the adult) constituted the inaugural symptom that preceded the apparition of endocardial vegetation. [ 15 – 17 ]…”

“…The invasive mechanism, with subsequent inducement of diffuse pyomyositis through direct muscular invasion, has been demonstrated through the isolation of the pathogen in the muscle tissue; [ 18 ] perimyositis can also be the initiating factor for rhabdomyolysis. [ 17 ] The toxemic mechanism through the implication of TSST during the toxic shock syndrome (TSS) is accepted, but was excluded in this case; there are reports that suggest the possibility of another nonsupurative toxemic mechanism, not mediated by TSST-1; a previous case of SEC-secreting MSSA sepsis associated rhabdomyolysis was reported in which, similarly, the patient presented purpura and embolic cerebral complications but without of endocardial determination. [ 12 ] In the absence of muscle biopsy, we consider pyomyositis as most likely, but we cannot fully exclude the involvement of one or more enterotoxins.…”