Moore Timothy, Boyle Brandon B, Urumov Andrej, Calder Scott, Martini Wayne A
Emergency Medicine, Mayo Clinic Alix School of Medicine, Scottsdale, USA.
Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, USA.
Cureus. 2024 Oct 14;16(10):e71491. doi: 10.7759/cureus.71491. eCollection 2024 Oct.
Pneumococcal infective endocarditis (PIE) is a rare but serious infection often presenting with systemic complications such as septic emboli, myocarditis, and septic arthritis. This case report highlights a 49-year-old male who presented with acute-on-chronic lower back pain and fever, later diagnosed with PIE complicated by septic spinal arthritis, paraspinal myositis, and developing myocarditis. A 49-year-old male presented to the emergency department (ED) with worsening back pain and fever after treatment failure for suspected pyelonephritis. Laboratory studies revealed leukocytosis, hypercalcemia, and acute kidney injury, while magnetic resonance imaging (MRI) identified septic facet arthritis and abscess formation. A transesophageal echocardiogram (TEE) revealed aortic valve vegetations consistent with infective endocarditis (IE). The patient required aortic valve replacement and prolonged hospital stay due to sepsis and respiratory failure. He recovered within 12 weeks with only moderate residual heart failure symptoms. This case highlights the medical complexities and difficulties of treating IE, as well as the critical importance of having it on a wide differential due to increased morbidity and mortality with delay of diagnosis, antibiotics, and surgical intervention.
肺炎球菌感染性心内膜炎（PIE）是一种罕见但严重的感染，常伴有败血症性栓子、心肌炎和败血症性关节炎等全身并发症。本病例报告重点介绍了一名49岁男性，他最初表现为慢性下背部疼痛急性发作并伴有发热，后来被诊断为PIE，并发败血症性脊椎关节炎、椎旁肌炎，并发展为心肌炎。一名49岁男性因疑似肾盂肾炎治疗失败后，背痛加重并伴有发热，前往急诊科就诊。实验室检查显示白细胞增多、高钙血症和急性肾损伤，而磁共振成像（MRI）发现了感染性小关节关节炎和脓肿形成。经食管超声心动图（TEE）显示主动脉瓣赘生物，符合感染性心内膜炎（IE）。由于败血症和呼吸衰竭，患者需要进行主动脉瓣置换术，并延长住院时间。他在12周内康复，仅遗留中度残余心力衰竭症状。本病例突出了治疗IE的医学复杂性和困难，以及由于诊断、抗生素治疗和手术干预延迟会增加发病率和死亡率，因此广泛鉴别诊断该病的至关重要性。
