18 April 2019
: Case report
Cardiac Point-of-Care Ultrasound for the Diagnosis of Infective Endocarditis in a Patient with Non-Specific Rheumatologic Symptoms and Glomerulonephritis
Mistake in diagnosis
Brett G. Fischer1BEF*, Amiran Baduashvili1BEFDOI: 10.12659/AJCR.914708
Am J Case Rep 2019; 20:542-547
Abstract
BACKGROUND: Point-of-care ultrasound (POCUS) is performed at the bedside by a healthcare professional who is directly caring for the patient. Subacute infective endocarditis can be challenging to diagnose, as patients often present with non-specific symptoms. The modified Duke criteria include echocardiographic findings as a major criterion, but the role of POCUS has not been established. This report is of a case of infective endocarditis diagnosed using POCUS.
CASE REPORT: A 57-year-old man was admitted to hospital with a presumptive diagnosis of rapidly progressive glomerulonephritis secondary to vasculitis associated with a non-specific rheumatologic condition that had developed during the previous three months. Several specialist physicians had previously examined him. On hospital admission, POCUS was performed by the internal medicine physician, which showed mitral valve endocarditis resulting in a change in clinical management from steroid therapy to antibiotic therapy. Blood cultures were performed, which grew Streptococcus mutans.
CONCLUSIONS: To our knowledge, this is the first reported case of infective endocarditis diagnosed by an internist using POCUS in a patient admitted to hospital with an alternative diagnosis and management plan in place. This case highlights the potential role of POCUS in the acute hospital setting and supports the need for studies to compare the diagnostic performance of POCUS with transthoracic echocardiography for the detection of valvular vegetations. POCUS may be considered for patients with a possible diagnosis of infective endocarditis that cannot be excluded using the modified Duke criteria, potentially resulting in earlier diagnosis and management, with an improved clinical outcome.
Keywords: Early Diagnosis, Echocardiography, Endocarditis, Internal Medicine, Point-of-Care Systems, Ultrasonography, Anti-Bacterial Agents, conservative treatment, Echocardiography, Doppler, Emergency Service, Hospital, Endocarditis, Bacterial, Follow-Up Studies, Glomerulonephritis, Mitral Valve Stenosis, Multimorbidity, Rheumatic Diseases, Risk Assessment, Streptococcal Infections, Streptococcus mutans, Stroke
In Press
Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.945853
Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.947512
Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.946691
Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.946969
Most Viewed Current Articles
21 Jun 2024 : Case report
96,359
DOI :10.12659/AJCR.944371
Am J Case Rep 2024; 25:e944371
07 Mar 2024 : Case report
52,229
DOI :10.12659/AJCR.943133
Am J Case Rep 2024; 25:e943133
20 Nov 2023 : Case report
31,248
DOI :10.12659/AJCR.941424
Am J Case Rep 2023; 24:e941424
18 Feb 2024 : Case report
23,387
DOI :10.12659/AJCR.943030
Am J Case Rep 2024; 25:e943030