A wolf in another wolf’s clothing

Abstract

This case of infective endocarditis masquerading as mixed cryoglobulinemia in a man with a history of intravenous drug use (IVDU) and hepatitis C virus (HCV) highlights the importance of maintaining a broad differential and continually re-evaluating the working diagnosis as new information presents itself. The patient presented to an outside hospital and was treated for presumptive mixed cryoglobulinemia with corticosteroid therapy. When the patient did not improve, he was transferred to a tertiary care center for possible Rituximab and/or plasmapheresis. Further investigation revealed Enterococcus bacteremia with subsequent workup consistent with infective endocarditis (IE). This case highlights a diagnostic dilemma and demonstrates the importance of a thorough evaluation as it pertains to overlapping features of IE and mixed cryoglobulinemia.

Cryoglobulinemic vasculitis in two patients with infective endocarditis: a case series

“…In other cases, cryoglobulinemic vasculitis may be misdiagnosed as being a primary auto-immune disorder rather than the result of an underlying infection. Lamba et al 13 and Agarwal et al 14 reported separate cases of patients who presented with mixed cryoglobulinemia that were treated with high-dose steroids with worsening of their clinical condition before ultimately being diagnosed with infectious endocarditis. In both cases, treatment of the endocarditis resolved the underlying cryoglobulinemic vasculitis.…”

“…It appears that a number of organisms can lead to development of endocarditis associated cryoglobulinemic vasculitis as published reports include patients infected with MSSA, MRSA, Enterococcus spp., Streptococcus spp., Coagulase negative Staphylococcus, Kingella Kingae and Bartonella. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] While there have been multiple examples of individually reported cases, to the authors knowledge the only other case series of cryoglobulinemic vasculitis in the setting of endocarditis was published by La Civita et al 15 in 2002. Notably, in that series the two case were identified 5 years apart.…”