Musculoskeletal Manifestations of Bacterial Endocarditis

Abstract

In a retrospective analysis of bacterial endocarditis, 84 of 192 cases (44%) were found to have musculoskeletal manifestations of one or more types. Common manifestations were arthralgias (32 cases), arthritis (26 cases), low back pain (24 cases), diffuse myalgia (16 cases), and myalgias localized to the thigh or calf (11 cases). The joint manifestations typically were monarticular or oligoarticular, and the myalgias were commonly unilateral. No association was found between the pattern of rheumatic symptoms and other clinical manifestations, laboratory tests, or causative bacterial organisms. In 52 patients (27%), musculoskeletal complaints were the first or among the first symptoms of bacterial endocarditis. The frequency and character of these manifestations and their tendency to occur early in the course of the disease indicate that they are an important feature of endocarditis which, if not recognized, may cause a delay in the diagnosis by mimicking a rheumatic disease.

Post-surgical Infective Endocarditis Involving Chordae Tendinae: A Rare Presentation

“…Literature search showed vegetations mainly arising from valves (native or prosthetic), interventricular septum, mural endocardium and intracardiac devices [4]. In our patient, vegetations originated from chordae tendinae and our differential diagnosis was fibroelastoma of chordae tendinae, chordae tendinae rupture, vegetations arising from valves and extending to chordae tendinae and post mitral valve repair with retained chordae tendinae.…”

“…However, the frequency is very low as most patients at risk receive prophylactic antibiotics. Also, typical physical findings such as a fever and generalised fatigability are inconsistent, hence it is detected late [4]. Literature search has yielded only one case report following urology procedure wherein the patient had pre-existing mitral valve disease as a risk factor [3].…”

“…Initially IE occurs by formation of a sterile vegetations (contains platelets, fibrin and blood clots) on a valve that is damaged by valvular disease [4]. Vegetations usually occur at a site associated with high-speed blood flow or direct collision with the endocardial surface like valves (native or prosthetic), interventricular septum, mural endocardium and intracardiac devices.…”

“…Vegetations usually occur at a site associated with high-speed blood flow or direct collision with the endocardial surface like valves (native or prosthetic), interventricular septum, mural endocardium and intracardiac devices. Onset is rare at a site where normal-speed blood flow exists [4]. Sterile vegetations may get infected during/following transient bacteraemia associated with surgical procedures in the fields of dentistry, otorhinolaryngology, urology, and obstetrics and gynaecology [5].…”

Clinical Characteristics and Follow-Up Data in a Series of Twenty Infective Endocarditis Complicated of Rheumatic Manifestations

“…Radiological results have no specificity, whether by performing joint and bone radiographs or CT and MRI images [7]- [9].…”