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Subacute bacterial endocarditis presenting as polymyalgia rheumatica or giant cell arteritis

C. Auzary, D. Le Thi Huong, X. Delarbre, A. Sbai, F. Lhote, T. Papo, B. Wechsler, P. Cacoub, C. Martin-Hunyadi, J.-C. Piette

Department of Internal Medicine, Centre Hospitalier Moulins-Yzeure, Moulins, France

CER2778
2006 Vol.24, N°2 ,Suppl.41 - PI 0038, PF 0040
Case Report

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Rheumatology Article

 

Abstract

OBJECTIVES:
To report on several patients with subacute bacterial endocarditis who were initially presumed, incorrectly, to have polymyalgia rheumatica or giant cell arteritis.
METHODS:
We report 3 cases of subacute streptococcal endocarditis mimicking giant cell arteritis in 2 cases and polymyalgia rheumatica in one. We reviewed the literature through Medline search of French and English-language articles published between 1966 and 2005 and found 5 similar cases.
RESULTS:
Shoulder and/or pelvic girdle pain was associated with neck or back pain in all patients. Scalp tenderness, bilateral jaw pain, amaurosis fugax were present in 2 patients. One patient had no fever. Two patients were treated with corticosteroids with initial good clinical response in one. Appropriate antibiotic therapy resulted in the rapid disappearance of rheumatic complaints in 2 patients and achieved a definitive cure of endocarditis in all cases.
CONCLUSIONS:
Rheumatologic symptoms may hinder the correct diagnosis of infective endocarditis in patients who present with a clinical picture suggesting polymyalgia rheumatica or giant cell arteritis. In such cases, blood cultures should be systematically drawn.

PMID: 16859595 [PubMed]