Atypical Presentation of Infective Endocarditis in a Young Man without Risk Factors: A Case Report

Abstract

Infective endocarditis is a disease caused by the adherence of infectious agents to the endocardial surface, resulting in inflammation and damage, especially to the heart valves. Endocarditis may be diagnosed in up to 5% of patients with prolonged febrile syndrome. The incidence of endocarditis affecting the right heart chambers ranges from 5% to 10% with predominant involvement of the tricuspid valve. Pulmonary valve involvement is rare and usually associated with immunosuppressive conditions or structurally abnormal hearts. Pulmonary valve endocarditis may present atypically with recurrent respiratory symptoms, so that echocardiography should be considered to assess the presence of right heart lesions, which may be a challenge for suspicion and diagnosis, especially in patients without risk factors. In this study, the authors report a case of isolated infective endocarditis in the pulmonary valve due to Staphylococcus aureus in a young man with recurrent pneumonia episodes and without traditional risk factors. Although technological advances contribute to the diagnosis of complex cases, the clinical approach was the best way to determine the appropriate tests and examinations, and for choosing or developing interventions. Despite the availability of resources and diagnostic tools, many diseases associated with high morbidity and mortality may be misdiagnosed and mistreated, including infective endocarditis. A comprehensive patient assessment is essential for the correct diagnosis, as many signs and symptoms are common to different diseases.