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Endocarditis diagnosed as multilobar, community acquired pneumonia
  1. C D Muntan,
  2. M Haydel
  1. Section of Emergency Medicine, LSU-Charity Hospital, New Orleans, USA
  1. Correspondence to:
 Dr C D Muntan
 Section of Emergency Medicine, LSU-Charity Hospital, 1532 Tulane Avenue, 13th Floor, New Orleans, LA, USA; cmuntaluhsc.edu

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With the introduction of penicillin in the 1940s, the mortality rate from infective endocarditis (IE) decreased from 100% to about 30%.1 Despite newer antibiotics and other medical advances, the mortality rate remains 16% to 46%, and the annual incidence for the general population is 24 to 62 cases per million.2–11

Infective endocarditis has changed over the decades from a disease infecting rheumatic heart defects to an iatrogenic and self inflicted entity. With advances in invasive medical techniques and an increase in intravenous drug use, the prevalence of staphylococcus aureus has now surpassed streptococcus as the most common cause of IE.11–13 In addition, there is an increasing prevalence of resistant bacteria, poor compliance with treatment regimens, and risk of complications years later.8–10,14

The initial presentation to the emergency department (ED) is usually vague and non-specific, especially among intravenous drug users, and the number of missed diagnoses is unknown.15 The following case illustrates IE and its presentation and management.

A 23 year old woman presented to the ED …

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