OSTEOMYELITIS AND INFECTIVE ENDOCARDITIS

Osteomyelitis is thought to occur as a complication of infectious endo carditis in as many as 6% of cases of endocarditis. We describe this a ssociation in three patients. Osteomyelitis may be difficult to diagno se in patients with endocarditis because symptoms such as fever, bone pain and stiffness are common to both illnesses, therefore physicians need to have a high index of suspicion to avoid missing this important complication. We recommend that patients with endocarditis and persis tent or localized musculoskeletal symptoms should be investigated to e xclude osteomyelitis. Plain radiographs can be normal in 50% of cases of osteomyelitis in the early stages or show only minor abnormalities, but bone scans are highly sensitive. We suggest that a bone scan is p erformed if radiography is unhelpful, since a diagnosis of osteomyelit is can effectively be excluded if the bone scan is normal. We advocate close follow-up of these patients with prolonged antibiotic treatment consisting of at least 6 weeks of intravenous therapy, and 3 months o r longer of oral therapy.