8 Months now...Is it Endocarditis?

[Debie__0__0]

Posted by Debbie on April 18, 1999 at 15:09:45
I am a 29 year old white female with a functional flow murmur.  I was initially treated for endocarditis  about 5 years ago after having a fever, nail splinters and fatigue for a while.  After 5 days of IV antibiotics my cutlures came back negative and I was sent home with no further treatment.
Approx. 8 months ago I found a lump under my left jaw/neck in a lymph node a little smaller than a marble.  It is perfectly round and is mobile under the skin. I also noticed that I had a slight fever (99.5).  Over the next few months I developed 2 more lumps in the same spot on the right side, then two smaller ones, one on my jawline, and one in my neck near my ear.  I have run a fever from normal to 100 on and off throughout.  I've also had some episodes of chest pain.  I've been tired, but am active and certainly have not had what I would consider serious symptoms.  Without the fever and Lymph node lumps I'd assume that I was fine.
I had a CBC, HIV, Sed rate, and something that tests for leukemia I think in December/January.  All was normal except for mild anemia.
I had an echo that showed a definite vegetation an a valve.  The drew bloods for endocarditic culture.  I was sent for a TEE which was normal.  one of the cultures came back positive, but it was contaminated.
The symptoms have remained the same, but another lump has showed up. I've had a 3 nail splinters show up. My Doctor reordered all blood tests, but still suspects endocarditis.  I'm going for a chest CAT this week.
He is considering beginning treatment for (empirical trial I think he called it) endocarditis if all else comes back normal.  
Does this sounds like endocarditis?  Any other ideas?  Any input would be appreciated.  Thanks!
Debbie


Posted by CCF CARDIO MD - MTR on April 21, 1999 at 15:41:48
Dear Debbie, thank you for your question.  I don't think that you currently have endocarditis, but you must remember that I am unable to make diagnoses in the heart forum.  The fevers and lymph node enlargement signal to me that you may have a systemic inflammatory disorder rather than endocarditis.  I think the next step should be consideration of a lymph node biopsy.  If your TEE was normal (despite what the surface echo showed) and your blood cultures are negative, I think it would be very unlikely that you have endocarditis.  There are some cases of so-called "culture-negative endocarditis" where empiric IV antibiotic therapy is needed when the diagnosis is not clearly established.  However, I don't think that category would include you from that information you've provided.  Thus, I suggest that you speak to your physician again and discuss all the options.
I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies. Please feel free to write back with additional questions.  Good luck!
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter.   The Heart
Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.