ARTHRITIS AND MENINGITIS - THE FIRST MANIFESTATIONS OF BACTERIAL-ENDOCARDITIS IN 2 PATIENTS

We have encountered 2 patients in whom the first manifestations of bac terial endocarditis were arthritis (in 1 case septic arthritis and in the other nonseptic arthritis) and bacterial meningitis. These present ations were followed by acute heart failure due to aortic valve destru ction, although the patients showed no significant cardiovascular mani festations on admission. Aortic valve replacement was performed in eac h case and the patients' postoperative course was comfortable. We woul d like to emphasize the following points. (1) Arthritis and meningitis are uncommon in patients with bacterial endocarditis. However, it is necessary to consider the possibility of bacterial endocarditis when t hese clinical manifestations present together. Such a combination can cause rapid valve destruction. When more than 2 rare complications of bacterial endocarditis coexist, surgery should be considered as soon a s the definite diagnosis of bacterial endocarditis is established, eve n if congestive heart failure has not yet developed. (2) Arthritis ass ociated with bacterial endocarditis might be truly septic rather than mediated by circulating immune complexes as is commonly believed.