Osteoarticular infection complicating enterococcal endocarditis.
Despite the common occurrence of musculoskeletal complaints in patients with infective endocarditis, infectious osteoarticular complications are diagnosed infrequently. Moreover, although enterococcal infection is the third most common cause of infective endocarditis, infectious osteoarticular complications are rare. We report a case of disk space infection in a patient with enterococcal endocarditis. Blood cultures and an L3-4 aspirate grew Enterococcus faecalis, and transthoracic echocardiography revealed a large vegetation on the posterior mitral valve leaflet. The osteoarticular infection resolved with antimicrobial treatment, but worsening heart failure necessitated valve replacement surgery. The patient had an uneventful recovery with no evidence of recurrence or complications. A review of the medical literature from 1966 through 1998 identified 13 additional cases, only 8 of which provided clinical and treatment data. We present the clinical and laboratory findings reported in these cases, along with data from our patient. This report highlights the rare occurrence of osteoarticular infection in the setting of enterococcal endocarditis and emphasizes early recognition and treatment.
Division of Pulmonary and Critical Care Medicine and Internal Medicine, Mayo Clinic, Rochester, Minn 55905, USA. vlahakis.nicholas@mayo.edu
Nicholas E
NE
Vlahakis
Zelalem
Z
Temesgen
Elie F
EF
Berbari
James M
JM
Steckelberg
D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001170:Arthritis, Infectious / Q000188:drug therapy / Q000382:microbiology*; D004697:Endocarditis, Bacterial / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology; D013293:Enterococcus faecalis / Q000302:isolation & purification; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D008499:Medical Records; D008875:Middle Aged; D010000:Osteitis / Q000188:drug therapy / Q000382:microbiology*; D010400:Penicillin G / Q000008:administration & dosage; D012189:Retrospective Studies; D013307:Streptomycin / Q000008:administration & dosage; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D010400:Penicillin G; D013307:Streptomycin