Join-involvement in infective endocarditis

Abstract

Introduction: infectious Endocarditis (IE) is a serious disease with incidence of 3-10 to 100.000 episodes per year, late diagnosis establishing (36-40%), fatal complications: congestive heart failure in 30%, embolic phenomena in 20%, stroke 15%. Joint manifestations in patients with IE are rare, they are manifested by: arthritis-6.4%, sinovitis-2.8% and creates difficulties in establishing early diagnosis. Clinical Case: Patient Y., 47 years old, Diagnosis: Active Infectious Endocarditis with negative hemocultures with native valve involvement(aortic valve (AoV), mitral (MV) and the pulmonary artery (PA)), MV failure of III degree, AoV II degree, VAp II degree, HF II NYHA. Chronic Periodontitis. Chronic hepatitis of viral etiology (HCV), moderate activity. Results: subfebrility inspiratory dyspnea, palpitations, pain of the mean-severe severity in shoulder joint, elbow joint, coxofemural joint, lumbalgias, fatigue. Objective: tegumental peteschias, tumefiation of the periarticular regions, rhytmic heart beats, atenuated, BP-135/60 mmHg. FCC-105 b/min. Vesicular murmur in lungs. ECG: Sinusal tachycardia with frequency of 102 beats per minute. EAH - horizontal. EcoCG: Moderate dilatation of LA, RV, RA. EF-65%. Plate vegitations, floating on the anterior and posterior cusps and MV (7 x 10 mm), floating vegetations of the AoV cusps, MV failure, III degree, AoV-II degree, TrV-III degree, ApV-I degree, moderate PHT, PsVD-36 mmHg. General blood analysis: anemia (Hb-102 g/l), ESR-40 mm/HR. Biochemical analysis: total bilirubin 25 mmol/l, ALT-49.9 mmol/l, AST-66.9 mmol/l, GGT U/l-295.4. General urine analysis: leucocitury, immunological tests: Anti-HCV-positive, rheumatoid factor-44 IU/ml, C-reactive protein-384 mg/l. Negative hemocultures.Empirical antimicrobial treatment with sol. Vancomycin-60 mg/kg/day, i/v in 2-3 plugs, Sol. Gentamicin-3 mg/kg/day, i/v in a single dose, antifungal, antiinflammatory drugs, diuretics.Conclusions: Patient 47-year-old young man with chronic oral bacteriemia develops IE with polyarticular syndrome from the begining, that creates difficulties in early diagnosis establishing and lates appropriate antimicrobial treatment.