A case of endocarditis presenting with icterus

Staphylococcus aureus (S. aureus) bacteremia (SAB) may be complicated by hematogenous seeding to host tissues that the cardiac valves are the major site of metastatic infection. Herein, we presented a case of endocarditis presenting with icterus in the Capital of Iran. The case was a 36-year-old man with chief complaint of fever and shaking chills for the past week. On examination, the patient was ill, but he was not toxic. Besides the high fever, he had a pulse of 110 beats/min, blood pressure of 110/70mmHg and a respiratory rate of 20 breaths/min. His skin was not icteric and no rash and legion were found, but sclera was icteric. An abdominal examination revealed no tenderness, rigidity, ascites, organomegaly or masses. Peripheral blood smear (PBS) was examined for malaria and burrelia in three times and it was negative. On the eighth day of admission, blood culture reported and it was positive for S. aureus. Treatment with Vancomycin was started and Trans esophageal echocardiography (TEE) was requested. There was a response to treatment with stopping of fever, reducing the size of tricuspid vegetative mass and changing of second blood culture to negative. Treatment course was completed and the patient discharged with good condition. In conclusion, careful evaluation of prior medical records and clinical course can be very helpful. Echocardiography and serial blood cultures provide the key to diagnosis. TEE is recommended in all patients with SAB to determine whether they have S. aureus infective endocarditis.