SHM Converge Scientific Abstract ePoster Gallery-Infective Endocarditis Masquerading as a Gout Flare

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A 76-year-old man with atrial fibrillation and gout presented with dizziness and headache. Initial laboratory testing and brain MRI were unrevealing, but he later developed acute pain in the right ankle and left shoulder, followed by additional pain in the left wrist and knee. Because of his gout history, he was initially treated for a presumed gout flare despite remaining afebrile and having a normal leukocyte count. He was also noted to have a subungual hemorrhage.

Blood cultures ultimately grew <em>Streptococcus dysgalactiae</em>. Arthrocentesis of the affected joint confirmed septic arthritis, showing a high polymorphonuclear count, no crystals, and a positive culture for the same organism. Further evaluation with transthoracic echocardiography revealed a small aortic valve vegetation, confirming infective endocarditis. He was treated with six weeks of intravenous penicillin.

This case illustrates how infective endocarditis can masquerade as gout or another inflammatory arthropathy, especially when classic signs such as fever, leukocytosis, or a murmur are absent. <em>Streptococcus dysgalactiae</em> is an uncommon but increasingly recognized cause of infective endocarditis in older adults. The report emphasizes that any new inflamed joint should prompt early arthrocentesis, since septic arthritis may be the first clue to underlying bacteremia or endocarditis.

Asset Subtitle

Seonghee Choi

Meta Tag

Author List SVETLANA Chernyavsky, Seonghee Choi

Category Clinical Vignettes

Concept Infective Endocarditis

Concept Septic Arthritis

Concept Arthrocentesis

Concept Gout

Concept Bacteremia

Distinguished Non-Finalist

Presenter Organization Mount Sinai Morningside/West

Presenting Author Seonghee Choi

Track Adult

Keywords

infective endocarditis

Streptococcus dysgalactiae

septic arthritis

gout mimic

arthrocentesis

blood cultures

aortic valve vegetation

bacteremia

polyarticular pain

intravenous penicillin

Infective Endocarditis

Septic Arthritis

Arthrocentesis

Gout

Bacteremia