INFECTIVE ENDOCARDITIS AS INITIAL MANIFES TATION OF ON EMBOLIZING ENDOCARDITIS OF THE AORTIC-VALVE

History and clinical findings: A 47-year-old patient was admitted to h ospital with fever (39.2 degrees C), weight loss and sore throat. The right thyroid area was painful on palpation. Investigations: The eryth rocyte sedimentation Fate was 56/86 mm, white blood cell count 10,600/ I, with shift to the left and toxic granulations. Blood culture grew S treptococcus mitis; the echocardiogram showed vegetations on the aorti c valve. Therefore aortic valve endocatidits was suspected. Ultrasound examination of the thyroid gland showed an echo poor area with an enl arged thyroid artery; thyroid cytodiagnosis was unremarkable. Treatmen t: The fever quickly subsided on administration of penicillin G (7.5 m ill I.U. three times daily) and tobramycin (80 mg three times daily) f or two weeks, followed by penicillin G in the same dosage for four mor e weeks. Vancomycin was then given for two weeks (1 g twice daily intr avenously). The aortic valve vegetations were no longer seen three wee ks after onset of treatment. Two months after discharge the thyroid an d heart were normal on ultrasound examination. Conclusion: Bacterial t hyroiditis was caused by embolisation to the thyroid artery from veget ations on the aortic valve in aortic valve endocarditis, probably due to carious teeth.