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Unusual presentation of infective endocarditis in ICU
  1. Marc Lincoln1,
  2. Zachary Holmes2,
  3. Alexander Robinson3 and
  4. Bart De Keulenaer4,5
  1. 1Murdoch Hospital Intensive Care Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
  2. 2General Medicine, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
  3. 3Emergency Department, Royal Perth Hospital, Perth, Western Australia, Australia
  4. 4Intensive Care, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
  5. 5School of Surgery, The University of Western Australia, Perth, Western Australia, Australia
  1. Correspondence to Professor Bart De Keulenaer; bart.dekeulenaer{at}


Bacterial endocarditis remains a challenging condition to manage owing to its variety of different presentations. This report describes a 55-year-old woman with endocarditis who presented confused with shoulder and back pain. Initial diagnosis was made difficult by a negative echocardiogram but aided by striking peripheral stigmata. She was treated for infective endocarditis as she met all five Duke’s minor criteria for infective endocarditis. Gallium scan was a useful investigation in identifying lumbar spine and acromioclavicular joint septic foci. This case highlights the challenges of diagnosing endocarditis. It also describes how gallium scans can be useful in identifying occult septic emboli in these patients.

  • valvar diseases
  • adult intensive care
  • radiology

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  • Contributors BdK was the consultant looking after this patient and provided expert input into the case. He was also involved in contributions to the discussion of this case and drafting the report. ML researched the case and was the principal contributor to all writing as well as contact with the patient to collect a patient's perspective. ZH was involved in researching the case and contributed considerably to the writing of the case, specifically the background to the case. He acted as a liason with the radiology department regarding queries with the images. He was also vital in critically revising the report. AR was involved in researching the case and also contributed to the writing of the case, specifically retrieving the case files and summarising the case presentation. He also was vital in revising the drafts of this report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.