Scratching Beneath the Surface
Journal of Hospital Medicine 13(5). 2018 May;347-352. Published online first February 9, 2018. | 10.12788/jhm.2931
February 1, 2018|Journal of Hospital Medicine
The approach to clinical conundrums by an expert clinician is revealed through the presentation of an actual patient’s case in an approach typical of a morning report. Similar to patient care, sequential pieces of information are provided to the clinician, who is unfamiliar with the case. The focus is on the thought processes of both the clinical team caring for the patient and the discussant.
© 2018 Society of Hospital Medicine
TEACHING POINTS
- Subacute IE typically presents with indolent constitutional symptoms over a course of weeks to months, whereas acute IE causes a rapid onset of fevers, rigors, and is more likely to exhibit embolic phenomena.
- Epidemiologic features specific to Bartonella species include alcoholism, cirrhosis, dog or cat exposure, homelessness, and body lice, and should be considered in suspected cases of BCNE.
- If suspicion for endocarditis remains high and animal exposure is elicited, then serologic and PCR testing for fastidious organisms should be strongly considered. The most common causes of BCNE include Coxiella, Bartonella, and Brucella species.
- The modified Duke criteria do not incorporate Bartonella within the diagnostic schema. Presentation is usually late and often requires valve replacement.
Acknowledgments
The authors thank Dr. Michael Pfeiffer from the Pennsylvania State Hershey Heart and Vascular Institute for providing his expertise in diagnostic echocardiography.
Disclosure
There are no conflicts of interest or financial disclosures to report.
