Rheumatic Polyarthritis Revealing Infectious Endocarditis: A Case Report

Abstract

Infectious endocarditis is an infrequent but serious disease with multiple complications, as reported by the European society of cardiology in 2015. Rheumatic manifestations are some of the frequently encountered but rarely described complications. Even less described is the polyarticular involvement, which is rarely encountered in infective endocarditis. It is in this order that we report the case of a 34 years old patient followed for one month in the internal medicine department for rheumatoid polyarthritis, a diagnosis established due to polyarthritis, fever and positive anti-CCP. The patient underwent methotrexate and corticoid treatment. The evolution under treatment was marked by the persistence of the fever and the appearance of a drop in visual acuity, thus making the object of a transthoracic ultrasound scan. The ultrasound results showed a pulsatile and mobile hyperechoic image measuring 19x9 mm on the side of the large mitral valve associated with severe mitral insufficiency due to the pillar rupture of the small mitral valve. Three series of 30-minute blood cultures were performed, showing streptococcus constellatus. An assessment of the extension, in particular OCT-angiography showed macular hemorrhage. The circulating hypo complement objectively determined by C3 and C4 dosage, associated with positive anti-CCP allowed the patient to be treated for a rheumatological manifestation of infectious endocarditis. Initially the patient was treated with specific antibiotic therapy, followed by mitral valve replacement. After 2 months, the clinical picture improved. The rheumatic manifestations of infectious endocarditis are due to the antibody response to the infectious agent at the origin of the tissue lesions linked either to the deposition of preformed immune complexes, or to the interaction of antigens deposited in the tissues with the antibody-complement complex. Any unexplained rheumatological symptoms, accompanied by fever or a change in the general state of health must be reported.