Inaugural rheumatic manifestations in bacterial endocarditis. A review of 14 cases.

Rheumatic manifestations occur in 16% to 44% of patients with subacute bacterial endocarditis (SBE), frequently raising diagnostic problems especially when they are inaugural. Patients and methods: of 83 retrospectively reviewed patients with SEE seen over a ten-year period (1986-1997), 14 (16.8%) had inaugural rheumatic manifestations. Results: mean age in the 14 patients was 27.7 years (range, 15-60). Mean time from rheumatic symptom onset to diagnosis was 6.4 weeks (2-24). Blood cultures grew a group D streptococcus in ten cases and a Staphylococcus aureus in two. Articular manifestations were as follows: recurrent inflammatory arthralgia in the large joints (n = 9), aseptic arthritis of the knee (n = 1), and T9-T10 discitis followed six weeks later by SEE in the absence of a history of heart disease (n = 1). Seven patients reported myalgia that was either diffuse in distribution (n = 5) or confined to the calves (n = 2). Four patients with a mean age of 21 years (15-26) had digital clubbing not due to any other detectable cause. Eleven patients had a favorable outcome under antimicrobial therapy. The remaining three patients died (21.5%). Conclusion. Rheumatic manifestations are common in SEE and can delay the diagnosis when they inaugurate the disease, thus jeopardizing the patient's hopes of recovery. Early diagnosis based on careful analysis of the clinical setting would improve the prognosis of these still too often fatal rheumatic forms of SBE.