title: A rare case of enterobacter endocarditis superimposed on a mitral valve rheumatoid nodule.
abstract: We present the case of a 56-year-old man with longstanding seropositive active erosive and deforming rheumatoid arthritis with no peripheral rheumatoid nodules; he immigrated from the former Soviet Union (where he did not receive any disease-modifying antirheumatic drugs) to Israel in 1995. In February 2005, he had a buccogingival mucosal abscess on his lower lip, which was treated by surgical drainage, followed by prolonged antibiotic therapy. One and a half years later, he had 2 episodes of transient ischemic attacks characterized by speech difficulties and moderate weakness on his right side. Transesophageal echocardiogram revealed a mass on the anterior mitral valve leaflet. Repeated blood cultures were negative, and the patient was afebrile all the time. The patient underwent mitral valve replacement and the histologic findings of the mass were typical of both a rheumatoid nodule and bacterial endocarditis. The patient recovered fully after 6 weeks of antibiotic therapy. Emboli from a rheumatoid nodule should always be considered in patients with rheumatoid arthritis who present with transient ischemic attacks.
authors.affiliation: Department of Internal Medicine D, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors.forename: Hili
authors.initials: H
authors.lastname: Giladi
authors.forename: Shaul
authors.initials: S
authors.lastname: Sukenik
authors.forename: Daniel
authors.initials: D
authors.lastname: Flusser
authors.forename: Noah
authors.initials: N
authors.lastname: Liel-Cohen
authors.forename: Azai
authors.initials: A
authors.lastname: Applebaum
authors.forename: Netta
authors.initials: N
authors.lastname: Sion-Vardy
mesh_terms: D001172:Arthritis, Rheumatoid / Q000150:complications*; D004452:Echocardiography; D004697:Endocarditis, Bacterial / Q000150:complications* / Q000382:microbiology / Q000601:surgery; D004754:Enterobacter / Q000472:pathogenicity*; D004756:Enterobacteriaceae Infections / Q000150:complications* / Q000473:pathology; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000276:immunology / Q000473:pathology; D009336:Necrosis; D012218:Rheumatoid Nodule / Q000150:complications* / Q000473:pathology