title: Fungal endocarditis presenting with right lumbar pain and femoral artery ischemia - An unusual case report.
abstract: Fungal endocarditis is a rare entity which has a poor outcome. Our case reports an atypical presentation of similar pathology now presenting with femoral artery ischemia in an immune competent individual. A 62-year Asian male presented with sudden onset of right sided lumbar pain. Initial clinical exam was consistent with right sided renal colic. Intravenous analgesia did not relieve the pain. Repeat clinical examination revealed absent right femoral artery pulsation. The patient underwent a Computerized tomography angiography of right lower extremity. Echocardiogram revealed valvular vegetations that were later revealed to be because of Aspergillus Terreus. This case highlights the atypical presentation of a rare fungal endocarditis in an immune competent individual presenting with right sided lumbar pain. This case is of particular interest for emergency physicians who are at the forefront and may require to deal with such presentations.
authors.affiliation: Department of Emergency Medicine, Aga Khan University Hospital, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan.
authors.forename: Shahan
authors.initials: S
authors.lastname: Waheed
authors.affiliation: Department of Emergency Medicine, Aga Khan University Hospital, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan.
authors.forename: Muhammad Akbar
authors.initials: MA
authors.lastname: Baig
authors.affiliation: Department of Emergency Medicine, Aga Khan University Hospital, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan.
authors.forename: Muhammad Waqas
authors.initials: MW
authors.lastname: Khan
authors.affiliation: Department of Vascular Surgery, Aga Khan University Hospital, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan.
authors.forename: Fareed Ahmed
authors.initials: FA
authors.lastname: Sheikh
authors.affiliation: Department of Emergency Medicine, Aga Khan University Hospital, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan.
authors.forename: Nadeem Ullah
authors.initials: NU
authors.lastname: Khan
keywords: Emergency department; Femoral artery; Fungal endocarditis; Thromboembolism