Infective Endocarditis with Suspicion of Superimposed Acute Rheumatic Fever

Author : M.I. Amin, D.W. Anggrahini, B. Irawan
Upload Date : 19-04-2018

Background: Infective endocarditis is defined as the infection of endocardium, which includes one or more heart valves, mural endocardium, or septal defect. By the mid-20th century, most cases of Infective endocarditis were complications of rheumatic heart disease and bad oral hygiene. In developing countries, rheumatic heart disease remains the most predisposing heart condition. Even though both heart diseases are frequently found in a developing country, the occurrence of both happening simultaneously is highly rare.

Case Presentation: A woman aged 22 with a repeated history of fatigue particularly during moderate activities, beside another history of intermittent fever & dyspnea. Her physical examinations revealed that she had cardiomegaly, aside from machinery murmur with a degree of 4/6 auscultated. Electrocardiogram showed right axis deviation, T wave inversion at leads V1-V4, positive Katz-Wachtel phenomenon, followed by P-R Interval Prolongation. Transthoracic Echocardiography examination revealed severe mitral regurgitation, with multiple vegetation at mitral valves, mild aorta regurgitation compiled with three cusps calcification, and multiple vegetation at right coronary cusp. The findings revealed a patent ductus arteriosus with bidirectional shunt. During hospital inward care, laboratory data showed positive result of antistreptolysin titer O and elevated of C-reactive protein. Based on the data stated, the patient had the modified Jones and Dukes criteria checked simultaneously. Thus the patient was diagnosed with Infective endocarditis in suspicion of rheumatic fever.

Conclusion: Besides having similar signs and symptoms of an infective endocarditis and acute rheumatic fever, the difficulty in distinguishing between both of diseases as the cause of murmur/carditis (mitral regurgitation) is still challenging in this patient. Therefore, further research and routine follow up are needed to determine the best diagnostic and treatment approach toward patient's condition

KEYWORDS : Infective endocarditis - rheumatic fever - heart - Disease

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