A rare and difficult to diagnose case of subacute infective endocarditis caused by Bacillus cereus in a patient with systemic lupus erythematosus and Libman-Sacks endocarditis has been reported. Our aim is to highlight the importance of molecular methods such as MALDI-TOF and PCR to explain clinical and epidemiological issues about infections caused by unusual pathogen.

Background: Amyloidosis is a rare systemic disease characterized by the deposition of an insoluble protein, amyloid, in various tissues and organs. The disease is more prevalent in the elderly and can affect any organ, including the kidneys, heart, muscles or skin. Furthermore, clinical manifestations may be easily identified during a physical examination and serve as a clue to the diagnosing amyloidosis as well as its etiology. Case Report: The present paper describes the case of an elderly man presenting with macroglossia, "shoulder pad" sign and periorbital ecchymosis. A presumptive diagnosis of amyloidosis in its primary form was made by the attending physician. Afterwards, bone marrow biopsy confirmed multiple myeloma as the underlying cause and the patient was treated with chemotherapy. Conclusion: Macroglossia, "shoulder pad" and periorbital ecchymosis are important physical examination clues to diagnosis and etiology of amyloidosis.