# A Typical Case of Atypical Disease: "Three Noes" Infective Endocarditis

## TL;DR

A 16-year-old boy with atopic dermatitis had a rare form of infective endocarditis that initially showed no typical signs, highlighting the need for careful diagnosis.

## Contribution

The paper presents a novel case of 'three noes' infective endocarditis in a patient with atopic dermatitis, expanding clinical awareness of atypical presentations.

## Key findings

- A 16-year-old boy with atopic dermatitis presented with fever and chills but no typical heart infection signs.
- Diagnosis of tricuspid valve infective endocarditis was confirmed after symptoms relapsed.
- The case suggests a possible link between atopic dermatitis and atypical infective endocarditis.

## Abstract

Recognizing typical presentations of atypical cases is essential to reduce diagnostic errors and achieve better diagnoses. To better understand this, we report a typical case of “three noes” infective endocarditis (no left-sided, no intravenous drug use, and no intracardiac devices) with some different characteristics from well-known infective endocarditis. A 16-year-old boy with a history of atopic dermatitis presented with a one-month history of intermittent fever and shaking chills. The patient became afebrile with oral antibiotics, and initial investigations did not detect any evidence of bacterial infection, including heart murmurs and peripheral embolic manifestations. However, his symptoms relapsed one week after the cessation of antibiotics. A repeated workup revealed tricuspid valve infective endocarditis due to methicillin-susceptible Staphylococcus aureus. The relationship between atopic dermatitis and infective dermatitis has been reported in some literature, and clinicians should consider three noes infective endocarditis in patients with atopic dermatitis presenting with fever and unremarkable physical examination.