Vasculitis masquerading as aortic valve endocarditis

Small vessel vasculitis and endocarditis can both present with multisystem involvement and may present a diagnostic dilemma. Renal and cardiac involvement is common in small vessel vasculitis and rarely small vessel vasculitis may cause heart block. When a patient presents with diffuse symptoms, det...

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Bibliographic Details
Published in:Heart (British Cardiac Society) 2005-05, Vol.91 (5), p.e37-e37
Main Authors: Iqbal, M B, Fisher, N G, Fox, K M
Format: Article
Language:English
Subjects:
Acute Kidney Injury - etiology
Anti-Bacterial Agents - therapeutic use
Antibiotics
Aortic Valve
Biopsy
Cardiac arrhythmia
Diagnosis, Differential
Electronic Pages
endocarditis
Endocarditis, Bacterial - diagnosis
Heart attacks
heart block
Heart Block - diagnosis
Heart Block - etiology
Heart Valve Diseases - diagnosis
Humans
Immunoglobulins
Immunosuppressive Agents - therapeutic use
Inflammatory bowel disease
Kidneys
Lupus
Male
Microscopy
Middle Aged
Recurrence
Rheumatoid arthritis
small vessel vasculitis
Staphylococcal Infections - drug therapy
TOE
transoesophageal echocardiography
Vasculitis - diagnosis
Vasculitis - drug therapy
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Summary:Small vessel vasculitis and endocarditis can both present with multisystem involvement and may present a diagnostic dilemma. Renal and cardiac involvement is common in small vessel vasculitis and rarely small vessel vasculitis may cause heart block. When a patient presents with diffuse symptoms, deteriorating renal function, and heart block, endocarditis and vasculitis should be included in the differential diagnosis. The case is discussed of a man with a history of aortic valve endocarditis who presented again with similar symptoms, deteriorating renal function, and heart block. There was no evidence of aortic valve endocarditis with abscess formation. A renal biopsy confirmed small vessel vasculitis and the patient responded promptly to immunosuppressive treatment. Correct diagnosis is essential in such cases, as immunosuppression in true endocarditis can be catastrophic. In this case, with the correct diagnosis, immunosuppression proved life saving and prevented erroneous aortic valve surgery.
ISSN:1355-6037
1468-201X
DOI:10.1136/hrt.2005.060525