Musculoskeletal manifestations of infective endocarditis

Abstract

Introduction: Musculoscheletal manifestations in patients with infective endocarditis (IE) constitute 28-50%: artralgias (30%0, mialgias (20%), lumbalgias (16%), artritis (5,4%) and sinovitis (2,8 %). In mitral valve implication the rate of mortality consists from 37%, but in IE that is complicated with congestive heart failure – 65-85%. Clinical case: Pacient X, 71 years old, Diagnostics: active IE, stafilococcical etiology, with MV afecting (vegetations 2,5 mm), MV failure III degree, TsV failure II degree. HF III NYHA. Osteoartrosis, nodular form, III degree in association with rheumatoid artritis, poliartritis III degree. ACVD. Ictus in medium cerebral artery in the left. Results: subfebrility, palpitations, artralgias, fatiguee. Objective: hemiparesis in the right, motoric afazy, morning stiffness – 2 hours, simetric artritis in the metacarpo-falangian region, proximal interfalangian region, palore of the skin. Cardiac sounds are rhythmic, BP-170/80 mmHg. FCC-96 b/min. Hemoculture - Staphylococcus aureus. Leucocitosis, limphopenia, ESR elevated. Biochemistry: Pozitive Latex test, hipercreatininemy, uremy, elevated range of transaminasis. Urine analisys: leucocitury, hematury. ECG: Synusal tahicardy 100 b/min, left venrticle hypetrophy. Computer tomography (CT): CT sighns for ictus ischemic on the left. Multiple consecuances of the lacunar infarction that was supported bilateral in external capsula.Treatment: antibacterian, antimicotic, nonsteroidal antiinflamatory drugs, rheological, vascular, antiaritmic, diuretics. Conclusions: patients with IE with the background of rheumatoid artritis usually presents stafilococcical trigger, afecting mitral valve, complicated with congestive heart failure, ictus and cerebral oedema, that fatal defavorisates the prognosis.