J Korean Soc Emerg Med.  2015 Dec;26(6):605-608. 10.0000/jksem.2015.26.6.605.

A Case of Acute Infective Endocarditis Initially Presenting as Acute Pyelonephritis

• Lee YH
• Lee JH
• Choi BM
• Ko YJ
• Choi SK
• Lee YB
• Kim YM
• Kim YO

• KMID: 2191674
• DOI: http://doi.org/10.0000/jksem.2015.26.6.605

Abstract

Infective endocarditis carries high risk of morbidity and mortality. Rapid diagnosis and effective treatment are essential to good patient outcome. However, nonspecific symptoms and various clinical manifestations make early diagnosis difficult. Here we report on an unusual case of infective endocarditis initially presenting as acute pyelonephritis (APN). A 44-year-old female with a history of heart surgery was admitted for fever and both flank pain. The patient had undergone dental extraction 3 weeks prior to admission. Her lab work and physical examination revealed pyuria, positive bacterial culture of both blood and urine, costovertebral knocking tenderness, and CT findings consistent with APN, leading to her initial diagnosis as APN. Despite treatment with antibiotics, her symptoms did not improve while further physical examination revealed newly developed Osler's nodes and Janeway lesions. Echocardiography showed vegetation of the aortic valve with severe aortic regurgitation. She was diagnosed as a case of infective endocarditis and was treated successfully.

Keyword

Bacterial endocarditis; Pyelonephritis; Staphylococcus aureus

MeSH Terms

Adult
Anti-Bacterial Agents
Aortic Valve
Aortic Valve Insufficiency
Diagnosis
Early Diagnosis
Echocardiography
Endocarditis*
Endocarditis, Bacterial
Female
Fever
Flank Pain
Humans
Mortality
Physical Examination
Pyelonephritis*
Pyuria
Staphylococcus aureus
Thoracic Surgery
Anti-Bacterial Agents