A rare case of enterobacter endocarditis superimposed on a mitral valve rheumatoid nodule

Hili Giladi, Shaul Sukenik, Daniel Flusser, Noah Liel-Cohen, Azai Applebaum, Netta Sion-Vardy

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

Abstract

We present the case of a 56-year-old man with longstanding seropositive active erosive and deforming rheumatoid arthritis with no peripheral rheumatoid nodules; he immigrated from the former Soviet Union (where he did not receive any disease-modifying antirheumatic drugs) to Israel in 1995. In February 2005, he had a buccogingival mucosal abscess on his lower lip, which was treated by surgical drainage, followed by prolonged antibiotic therapy. One and a half years later, he had 2 episodes of transient ischemic attacks characterized by speech difficulties and moderate weakness on his right side. Transesophageal echocardiogram revealed a mass on the anterior mitral valve leaflet. Repeated blood cultures were negative, and the patient was afebrile all the time. The patient underwent mitral valve replacement and the histologic findings of the mass were typical of both a rheumatoid nodule and bacterial endocarditis. The patient recovered fully after 6 weeks of antibiotic therapy. Emboli from a rheumatoid nodule should always be considered in patients with rheumatoid arthritis who present with transient ischemic attacks.

Original languageEnglish
Pages (from-to)97-100
Number of pages4
JournalJournal of Clinical Rheumatology
Volume14
Issue number2
DOIs
StatePublished - 1 Apr 2008
Externally publishedYes

Keywords

  • Endocarditis
  • Mitral valve
  • Rheumatoid arthritis
  • Rheumatoid nodule

ASJC Scopus subject areas

  • Rheumatology

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