title: Subacute bacterial endocarditis presenting as polymyalgia rheumatica or giant cell arteritis.
abstract: 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.
authors.affiliation: Department of Internal Medicine, Centre Hospitalier Moulins-Yzeure, Moulins, France. c.auzary@ch-moulins-yzeure.fr
authors.forename: C
authors.initials: C
authors.lastname: Auzary
authors.forename: D
authors.initials: D
authors.lastname: Le Thi Huong
authors.forename: X
authors.initials: X
authors.lastname: Delarbre
authors.forename: A
authors.initials: A
authors.lastname: Sbai
authors.forename: F
authors.initials: F
authors.lastname: Lhote
authors.forename: T
authors.initials: T
authors.lastname: Papo
authors.forename: B
authors.initials: B
authors.lastname: Wechsler
authors.forename: P
authors.initials: P
authors.lastname: Cacoub
authors.forename: C
authors.initials: C
authors.lastname: Martin-Hunyadi
authors.forename: J-C
authors.initials: JC
authors.lastname: Piette
mesh_terms: 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
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents