title: A wolf in another wolf's clothing.
abstract: This case of infective endocarditis masquerading as mixed cryoglobulinemia in a man with a history of intravenous drug use (IVDU) and hepatitis C virus (HCV) highlights the importance of maintaining a broad differential and continually re-evaluating the working diagnosis as new information presents itself. The patient presented to an outside hospital and was treated for presumptive mixed cryoglobulinemia with corticosteroid therapy. When the patient did not improve, he was transferred to a tertiary care center for possible Rituximab and/or plasmapheresis. Further investigation revealedEnterococcusbacteremia with subsequent workup consistent with infective endocarditis (IE). This case highlights a diagnostic dilemma and demonstrates the importance of a thorough evaluation as it pertains to overlapping features of IE and mixed cryoglobulinemia.
authors.affiliation: Tulane University, Department of Internal Medicine, United States.
authors.forename: Amrit
authors.initials: A
authors.lastname: Lamba
authors.affiliation: Vanderbilt University, Department of Pathology, United States.
authors.forename: Meghan
authors.initials: M
authors.lastname: Kapp
authors.affiliation: Vanderbilt University, Department of Pathology, United States.
authors.forename: Paisit
authors.initials: P
authors.lastname: Paueksakon
authors.affiliation: Tulane University, Department of Internal Medicine, Division of Gastroenterology and Hepatology, United States.
authors.forename: Parth J
authors.initials: PJ
authors.lastname: Parekh
keywords: Clinical decision making; Clinical pathology; Hepatitis C; Infective endocarditis; Mixed cryoglobulinemia; Renal disease