Manifestations rhumatologiques des endocardites infectieuses

Abstract

Various and frequent rheumatologic manifestations of infectious endocarditis may be encountered in clinical practice. Most of the time, they consist of arthralgias, inflammatory or infectious arthritis, rachialgias, or infectious spondylitis. A diagnosis of infectious endocarditis should be evoked in any case of unexplained rheumatologic manifestation, in particular when it is associated with a fever or an alteration of the overall health status. The frequency of infectious spondylitis increases in streptococcal endocarditis whereas the frequency of the other rheumatologic manifestations is identical, whatever the responsible germ. Numerous immunological abnormalities have been described in infectious endocarditis, in particular the presence of the rheumatoid factor, and that of circulating immune complexes. Rheumatologic manifestations are positively correlated to the presence of circulating immune complexes. Cardiac ultrasonography and haemoculture are the basic investigations for the diagnosis of infectious endocarditis. The antibiotherapy-induced improvement of the rheumatologic manifestations evolves parallel with the progressive vanishing of the biologic inflammatory syndrome and immunological abnormalities.