Infective endocarditis in a new immigrant.

Infective endocarditis is a rare but potentially fatal cardiac infection associated with a mortality rate as high as 20% to 25%.1 Although endocarditis has become a disease of older patients and intravenous drug users in developed countries, in developing countries rheumatic heart disease remains the key risk factor for this infectious disease.2 Primary care providers in Canada are seeing a growing number of new immigrant and refugee patients. Every year Canada receives more than 500 000 permanent and temporary migrants; in 2008, 21 860 of these migrants were refugees.3 Patients who are newly arrived in Canada often face substantial barriers to receiving health care and are at risk of a rapid decline in health after arrival in Canada.4 This case of infective endocarditis in a newly arrived refugee, which was seen in an urban family medicine inpatient service, presented a number of diagnostic and management challenges that family physicians will increasingly face in a globalized world.