Subacute Infective Endocarditis Misdiagnosed as Polymyalgia Rheumatica: A Case Report

TL;DR

A man with subacute infective endocarditis was initially misdiagnosed with polymyalgia rheumatica, highlighting the need to consider bacterial infections in similar symptoms.

Contribution

This case report emphasizes the diagnostic challenge of distinguishing infective endocarditis from polymyalgia rheumatica.

Findings

The patient's symptoms were initially attributed to PMR but were later found to be due to subacute IE.

Delayed diagnosis occurred until valve destruction became clinically apparent.

The case underscores the importance of ruling out bacterial infections before starting immunosuppressive therapy.

Abstract

Infective endocarditis (IE) is a rare disease with a myriad of signs and symptoms that overlap with other systemic inflammatory disorders. We present the case of an otherwise healthy 57-year-old male patient with a three-month history of back pain, muscle weakness, and weight loss that was initially misdiagnosed as polymyalgia rheumatica (PMR), when in fact he had been suffering from subacute IE due to viridans streptococci. The patient’s diagnosis was delayed until there was clinically apparent valve destruction. Our case highlights the crucial importance of excluding clinically subacute bacterial infection in patients with vague constitutional and musculoskeletal symptoms, especially before commencing immunosuppression.

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