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J Korean Soc Emerg Med > Volume 26(6); 2015 > Article
Journal of The Korean Society of Emergency Medicine 2015;26(6): 605-608.
급성 신우신염으로 발현한 감염성 심내막염1례
이윤희1, 이진희1, 최보미1, 고영재1, 최수경1, 이영복1, 김영민2, 김영옥1
1가톨릭대학교 의과대학 내과학교실
2가톨릭대학교 의과대학 응급의학교실
A Case of Acute Infective Endocarditis Initially Presenting as Acute Pyelonephritis
Youn Hee Lee1, Jin Hee Lee1, Bo Mi Choi1, Young Jae Ko1, Soo Kyoung Choi1, Yeong Bok Lee1, Young-Min Kim2, Young Ok Kim1
1Departments of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
2Departments of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
Correspondence  Young Ok Kim ,Tel: 031) 820-3347, Fax: 031) 847-2719, Email: cmckyo@catholic.ac.kr,
Received: June 5, 2015; Revised: June 9, 2015   Accepted: August 25, 2015.  Published online: December 30, 2015.
Infective endocarditis carries high risk of morbidity and mortality. Rapid diagnosis and effective treatment are essential to good patient outcome. However, nonspecific symptoms and various clinical manifestations make early diagnosis difficult. Here we report on an unusual case of infective endocarditis initially presenting as acute pyelonephritis (APN). A 44-year-old female with a history of heart surgery was admitted for fever and both flank pain. The patient had undergone dental extraction 3 weeks prior to admission. Her lab work and physical examination revealed pyuria, positive bacterial culture of both blood and urine, costovertebral knocking tenderness, and CT findings consistent with APN, leading to her initial diagnosis as APN. Despite treatment with antibiotics, her symptoms did not improve while further physical examination revealed newly developed Osler’s nodes and Janeway lesions. Echocardiography showed vegetation of the aortic valve with severe aortic regurgitation. She was diagnosed as a case of infective endocarditis and was treated successfully.
Key words: Bacterial endocarditis, Pyelonephritis, Staphylococcus aureus
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