title: A rare case of group A streptococcal endocarditis with absence of valvular vegetation.
abstract: Group A streptococcal endocarditis has been described in intravenous drug misusers and as a post-varicella infection in children. We report a 64-year-old man with no prior risk factors who presented with a persistent fever, malaise, polyuria and cola-colored urine. On examination peripheral stigmata of endocarditis without a cardiac murmur and asymptomatic pharyngeal exudates were found. Blood and urine analysis revealed renal failure from suspected glomerulonephritis. Blood cultures revealed fully sensitive Group A streptococci. Transthoracic and transesophageal echocardiographies revealed no vegetation. The Modified Duke's Criteria aided in the diagnosis of definite infective endocarditis, despite the absence of valvular vegetation.
authors.affiliation: Department of General Internal Medicine, Shonan Kamakura General Hospital, Kamakura. skghjpn@gmail.com
authors.forename: Joel
authors.initials: J
authors.lastname: Branch
authors.forename: Yu
authors.initials: Y
authors.lastname: Suganami
authors.forename: Izumi
authors.initials: I
authors.lastname: Kitagawa
authors.forename: Gerald H
authors.initials: GH
authors.lastname: Stein
authors.forename: Eri
authors.initials: E
authors.lastname: Tanaka
mesh_terms: D004697:Endocarditis, Bacterial / Q000175:diagnosis* / Q000382:microbiology; D006349:Heart Valve Diseases / Q000382:microbiology / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011135:Polysaccharides, Bacterial / Q000302:isolation & purification; D013290:Streptococcal Infections / Q000175:diagnosis* / Q000382:microbiology; D013297:Streptococcus pyogenes / Q000302:isolation & purification
chemical_list: D011135:Polysaccharides, Bacterial; C036112:streptococcal polysaccharide group A