KMID : 0385920150260060605
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Journal of the Korean Society of Emergency Medicine 2015 Volume.26 No. 6 p.605 ~ p.608
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A Case of Acute Infective Endocarditis Initially Presenting as Acute Pyelonephritis
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Lee Youn-Hee
Lee Jin-Hee Choi Bo-Mi Ko Young-Jae Choi Soo-Kyoung Lee Yeong-Bok Kim Young-Min Kim Young-Ok
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Abstract
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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.
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KEYWORD
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Bacterial endocarditis, Pyelonephritis, Staphylococcus aureus
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