title: Infective endocarditis initially presenting with a dermatomyositis-like syndrome.
abstract: Infective endocarditis (IE) may present with rheumatological manifestations such as myalgias, arthralgias, arthritis and back pain. However, muscle inflammation is rare. We present a case of a 68-year-old Hispanic man who presented with 1-month history of tiredness, weight loss, fever, myalgias, muscle weakness and dysphagia to solid food. On physical examination he had severe weakness in the proximal upper and lower extremities, and erythematous eruption involving the upper eyelids, neck and metacarpophalangeal joints. Creatine kinase levels were markedly elevated at 15 809 U/L. MRI of the right thigh revealed intermuscular and intramuscular oedema. Muscle biopsy showed acute necrotising suppurative perimyositis. Blood cultures were positive for methicillin-resistant Staphylococcus aureus. A transoesophageal echocardiogram revealed vegetations in the pulmonic valve. All clinical manifestations were resolved completely with broad-spectrum antibiotics. This case suggests that IE should be considered in the differential diagnosis of a patient presenting with inflammatory myopathy.
authors.affiliation: Department of Medicine, Division of Rheumatology, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico.
authors.forename: Joel
authors.initials: J
authors.lastname: Ojeda
authors.forename: Linnette
authors.initials: L
authors.lastname: López-López
authors.forename: Anarda
authors.initials: A
authors.lastname: González
authors.forename: Luis M
authors.initials: LM
authors.lastname: Vilá
mesh_terms: D000368:Aged; D016470:Bacteremia / Q000382:microbiology; D003680:Deglutition Disorders / Q000382:microbiology; D003882:Dermatomyositis / Q000175:diagnosis* / Q000209:etiology; D003937:Diagnosis, Differential; D004696:Endocarditis / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology; D005221:Fatigue / Q000382:microbiology; D005334:Fever / Q000382:microbiology; D006801:Humans; D008297:Male; D018908:Muscle Weakness / Q000382:microbiology; D063806:Myalgia / Q000382:microbiology; D009220:Myositis / Q000382:microbiology; D013203:Staphylococcal Infections; D013211:Staphylococcus aureus; D015431:Weight Loss