Kyhl Frederik, Rasmussen Rasmus Vedby, Lindhardsen Jesper, Smerup Morten, Fosbøl Emil L
Department of Cardiology, The Heart Centre, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark.
Department of Cardiology, Gentofte and Herlev Hospital, Copenhagen, Denmark.
Eur Heart J Case Rep. 2021 Jan 25;5(1):ytaa561. doi: 10.1093/ehjcr/ytaa561. eCollection 2021 Jan.
Rheumatoid arthritis (RA) may involve the cardiovascular system and can cause significant structural cardiac disease. RA mimicking infective endocarditis (IE) is rarely reported.
A 46-year-old man with a medical history of seropositive RA attended a planned outpatient visit for infliximab treatment. The pre-infusion examination revealed a pulse of 41 b.p.m. and the following electrocardiogram showed 3rd degree atrioventricular block. A temporary pacemaker was inserted, and subsequent transthoracic and transoesophageal echocardiograms showed severe aortic valve regurgitation with thickened cusps and thus raised suspicion of infective aortic endocarditis with root abscess. The patient underwent surgery with valve and root replacement the next day. What was thought to be IE, proved to be suppurative and granulomatous inflammation with sporadic necrosis and hyaline fibrosis, compatible with a rheumatoid nodule linked to the patient's RA diagnosis.
IE is a disease with high mortality and morbidity. In some cases of IE perivalvular cavities develop, most commonly abscesses and/or pseudoaneurysms, which necessitates surgery. Several conditions may mimic IE: for example, malignant and benign tumours, rheumatic diseases, and common age-related valve calcification. In patients with valvular vegetations that are 'culture-negative', alternative pathologies should be considered.
类风湿关节炎（RA）可能累及心血管系统，并可导致严重的结构性心脏病。类风湿关节炎酷似感染性心内膜炎（IE）的情况鲜有报道。
一名有血清阳性RA病史的46岁男性前来门诊接受英夫利昔单抗治疗。输液前检查发现脉搏为41次/分钟，随后的心电图显示为三度房室传导阻滞。插入了临时起搏器，随后的经胸和经食管超声心动图显示严重的主动脉瓣反流，瓣叶增厚，因此怀疑患有感染性主动脉心内膜炎并伴有根部脓肿。患者次日接受了瓣膜和根部置换手术。被认为是IE的病变，经证实为化脓性和肉芽肿性炎症，伴有散在坏死和透明样纤维化，符合与患者RA诊断相关的类风湿结节。
IE是一种死亡率和发病率都很高的疾病。在某些IE病例中会出现瓣周腔隙，最常见的是脓肿和/或假性动脉瘤，这就需要进行手术。有几种情况可能酷似IE：例如，恶性和良性肿瘤、风湿性疾病以及常见的与年龄相关的瓣膜钙化。在瓣膜有赘生物但“培养阴性”的患者中，应考虑其他病理情况。
