Diagnostic challenge: an atypical presentation of infective endocarditis

• Published in: BMJ case reports Vol. 14; no. 1; p. e239994
• Main Authors: Parente, Cristina Sarah, Sandland-Taylor, Laura Emma, Akhtar, Waheed
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 25.01.2021; BMJ Publishing Group
• Subjects: Antibiotics; Bacteremia - complications; Bacteremia - diagnosis; Blood; Blood Culture; C-Reactive Protein; Cardiology; Case Report; Case reports; Diagnosis, Differential; Diarrhea; Diarrhea - physiopathology; Dysentery - diagnosis; Early Warning Score; Echocardiography; Endocarditis; Endocarditis, Bacterial - complications; Endocarditis, Bacterial - diagnostic imaging; Endocarditis, Bacterial - physiopathology; Heart; Humans; Hypoxia; Lactic Acid; Leukocytosis; Lungs; Male; Medical diagnosis; Medical imaging; Middle Aged; Physiology; Pneumonia; Pneumonia - diagnosis; Pulmonary Embolism - diagnostic imaging; Pulmonary Embolism - etiology; Staphylococcal Infections; Tricuspid Valve Insufficiency - diagnostic imaging; Tricuspid Valve Insufficiency - etiology; Ultrasonic imaging; Urine; Vomiting; Vomiting - physiopathology; infections; medical education; valvar diseases; medical management
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2020-239994

It is recognised that infective endocarditis is frequently a challenging diagnosis to make, as it may present with a range of non-specific symptoms. A middle-aged man was admitted with an 8-day history of profuse non-bloody diarrhoea and vomiting. He had no medical history and no identifiable risk factors for infective endocarditis, and so this in combination with the patient’s atypical symptoms presented a diagnostic challenge. The patient was eventually diagnosed with a Staphylococcus aureus right-sided infective endocarditis. This case report explores the events which led to this diagnosis and demonstrates a number of unique learning points. It also highlights the importance of maintaining an open mind and being prepared to revise an initial diagnosis in the face of medical uncertainty.