Endocarditis: Osler’s challenge

Infectious endocarditis (IE) is a disease associated with infection of the endocardial surface. IE can cause a wide number of systemic findings and symptoms, often resembling a flu-like illness which makes diagnosis difficult. Many of these patients will present multiple times to the emergency department (ED) with symptoms. Though fever and murmur are present in the majority of cases, they may be absent at the time of initial presentation. Other findings such as Roth spots, Janeway lesions, Osler nodes, and so on are not common. An important element is consideration of risk factors. A patient with past or current intravenous drug abuse (IVDA) and fever should trigger consideration of IE. Other keys are multiple sites of infection, poor dentition, and abnormal culture results with atypical organisms. If a patient presents with risk factors for IE and endocarditis is suspected, admission for further evaluation is key. Blood cultures and echocardiogram are important diagnostic tests.