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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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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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creator	Iqbal, M B Fisher, N G Fox, K M
description	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.
doi_str_mv	10.1136/hrt.2005.060525
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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. 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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. 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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
title	Vasculitis masquerading as aortic valve endocarditis
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