Diagnostic challenge: an atypical presentation of infective endocarditis

BMJ Case Rep. 2021 Jan 25;14(1):e239994. doi: 10.1136/bcr-2020-239994.

Abstract

It is recognised that infective endocarditis is frequently a challenging diagnosis to make, as it may present with a range of non-specific symptoms. A middle-aged man was admitted with an 8-day history of profuse non-bloody diarrhoea and vomiting. He had no medical history and no identifiable risk factors for infective endocarditis, and so this in combination with the patient's atypical symptoms presented a diagnostic challenge. The patient was eventually diagnosed with a Staphylococcus aureus right-sided infective endocarditis. This case report explores the events which led to this diagnosis and demonstrates a number of unique learning points. It also highlights the importance of maintaining an open mind and being prepared to revise an initial diagnosis in the face of medical uncertainty.

Keywords: infections; medical education; medical management; valvar diseases.

Publication types

  • Case Reports

MeSH terms

  • Bacteremia / complications
  • Bacteremia / diagnosis*
  • Blood Culture
  • C-Reactive Protein
  • Diagnosis, Differential
  • Diarrhea / physiopathology
  • Dysentery / diagnosis*
  • Early Warning Score
  • Echocardiography
  • Endocarditis, Bacterial / complications
  • Endocarditis, Bacterial / diagnostic imaging*
  • Endocarditis, Bacterial / physiopathology
  • Humans
  • Hypoxia
  • Lactic Acid
  • Leukocytosis
  • Male
  • Middle Aged
  • Pneumonia / diagnosis*
  • Pulmonary Embolism / diagnostic imaging*
  • Pulmonary Embolism / etiology
  • Staphylococcal Infections
  • Tricuspid Valve Insufficiency / diagnostic imaging*
  • Tricuspid Valve Insufficiency / etiology
  • Vomiting / physiopathology

Substances

  • Lactic Acid
  • C-Reactive Protein