Subacute bacterial endocarditis presenting as polymyalgia rheumatica or giant cell arteritis.
OBJECTIVE
To report on several patients with subacute bacterial endocarditis who were initially presumed, incorrectly, to have polymyalgia rheumatica or giant cell arteritis.


METHODS
We report 3 cases of subacute streptococcal endocarditis mimicking giant cell arteritis in 2 cases and polymyalgia rheumatica in one. We reviewed the literature through Medline search of French and English-language articles published between 1966 and 2005 and found 5 similar cases.


RESULTS
Shoulder and/or pelvic girdle pain was associated with neck or back pain in all patients. Scalp tenderness, bilateral jaw pain, amaurosis fugax were present in 2 patients. One patient had no fever. Two patients were treated with corticosteroids with initial good clinical response in one. Appropriate antibiotic therapy resulted in the rapid disappearance of rheumatic complaints in 2 patients and achieved a definitive cure of endocarditis in all cases.


CONCLUSIONS
Rheumatologic symptoms may hinder the correct diagnosis of infective endocarditis in patients who present with a clinical picture suggesting polymyalgia rheumatica or giant cell arteritis. In such cases, blood cultures should be systematically drawn.
Auzary
C
C
Department of Internal Medicine, Centre Hospitalier Moulins-Yzeure, Moulins, France. c.auzary@ch-moulins-yzeure.fr
Le Thi Huong
D
D
Delarbre
X
X
Sbai
A
A
Lhote
F
F
Papo
T
T
Wechsler
B
B
Cacoub
P
P
Martin-Hunyadi
C
C
Piette
J-C
JC
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D004698:Endocarditis, Subacute Bacterial / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D013700:Giant Cell Arteritis / Q000175:diagnosis* / Q000503:physiopathology; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009141:Musculoskeletal System / Q000473:pathology / Q000503:physiopathology; D010146:Pain / Q000473:pathology / Q000503:physiopathology; D011111:Polymyalgia Rheumatica / Q000175:diagnosis*; D013290:Streptococcal Infections / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology
D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents