A case of infective endocarditis with buttock pain as a unique initial symptom

DOI 14 References
  • Kai Tomoko
    Critical Care Medical Center, Hiroshima Prefectual Hospital
  • Kaneko Kotaro
    Critical Care Medical Center, Hiroshima Prefectual Hospital
  • Karakawa Shinji
    Critical Care Medical Center, Hiroshima Prefectual Hospital
  • Doi Masao
    Critical Care Medical Center, Hiroshima Prefectual Hospital
  • Migita Takako
    Critical Care Medical Center, Hiroshima Prefectual Hospital
  • Ishihara Shin
    Critical Care Medical Center, Hiroshima Prefectual Hospital

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  • 仙腸関節炎を初発症状とした感染性心内膜炎の１症例

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Abstract

The patient was an 18-year-old female. About two months after beginning of illegal self-administration of psychostimulants, she developed fever of 40°C and was treated symptomatically at several institutes. Three months later, severe buttock pain on the left disabled her to stand up but two more months were needed to get diagnosed as pyrogenic sacroiliitis with sepsis. A CT scan detected inflammatory change in the left sacroiliac joint and γ-Streptococcus was cultured from a blood sample. Intravenous piperacillin was started, however, she developed congestive heart failure and transferred to our critical care medical center after all. The patient was in systemic inflammatory response syndrome with congestive heart failure and renal dysfunction upon arrival and echocardiography revealed tricuspid regurgitation (TR). Diagnosed as infective endocarditis (IE), she was administered 24 million units of Penicillin G per day as an initial dose. Her body temperature, white blood cell count, C-reactive protein, and serum creatinine values were gradually normalized within a month and her buttock pain was also disappeared. Valvoplasty was done in the 4th month for TR and she was discharged in 5th month. Although musculoskeletal symptoms appear in 25-44% of IE in previous reports, most of them are low back pain and buttock pain in the present case is extremely rare. IE resulting from drug abuse is increasing in number, therefore, clinicians should pay attention to those who manifest arthralgia and fever of unknown origin.

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