Prosthetic valve endocarditis secondary to Tropheryma whipplei in a patient with chronic polyarthritis.

BACKGROUND: Whipple's disease is a chronic multisystemic infectious disease that rarely presents as culture-negative endocarditis. Most patients reported with Tropheryma whipplei endocarditis involve a native valve and few describe prosthetic valve disease. CASE PRESENTATION: A patient with chronic polyarthritis and previous mitral valve replacement developed decompensated heart failure without fever. Transesophageal echocardiography revealed a prosthetic mitral valve vegetation and he underwent prosthetic mitral valve replacement. Blood and prosthetic mitral valve cultures were unrevealing. Broad-range polymerase chain reaction (PCR) of the extracted valve and subsequent Periodic-acid-Schiff (PAS) staining established the diagnosis of T. whipplei prosthetic valve endocarditis. CONCLUSION: Whipple's disease may present as culture-negative infective endocarditis and affect prosthetic valves. Histopathology with PAS staining and broad-range PCR of excised valves are essential for the diagnosis. Greater clinical awareness and implementation of these diagnostic procedures should result in an increased reported incidence of this rare disease.

Myocardial involvement in rocky mountain spotted fever: a case report and review.

Rocky Mountain Spotted Fever (RMSF), caused by Rickettia rickettsii, is a serious tickborne illness that is endemic in the southeastern United States. Although it is most commonly known as a cause of fever and rash, it can have systemic manifestations. The myocardium may rarely be involved, with symptoms that can mimic those of acute coronary syndromes. This report describes a case of serologically proven RMSF causing symptomatic myocarditis, manifested by chest pain, elevated cardiac enzyme levels, and decrease myocardial function. After treatment with antibiotics, the myocarditis resolved. Thus, although unusual, the clinician should be aware of myocardial disease in patients with appropriate exposure histories or other clinical signs of RMSF. Close monitoring and an aggressive approach are essential to reduce mortality rates.

Hypercalcemia caused by iatrogenic hypervitaminosis A.

Vitamin A toxicity produces protean clinical manifestations involving a wide variety of tissues and systems. Hypercalcemia can occasionally be associated with high vitamin A levels, but is rare. In this report we describe a patient who was receiving a commercially prepared enteral feeding formula for 2 years. He developed asymptomatic hypercalcemia and had serum vitamin A levels several fold above normal. Subsequently, a custom-made enteral feed was used which contained negligible amounts of vitamin A. Several months later, vitamin A levels diminished substantially and serum calcium levels returned to normal.

Risk-taking and health-seeking behavior in men with a history of urethritis: is there a learning curve?

BACKGROUND AND OBJECTIVES: Studies addressing how past experience with sexually transmitted diseases (STD) influence health-seeking behaviors among at-risk men are few. GOAL: The goal of this study was to determine whether health-seeking behaviors among men diagnosed with urethritis differ based on whether they report prior urethritis. STUDY DESIGN: Male STD clinic attendees answered a questionnaire regarding their demographic, sexual, and health-seeking characteristics. The men were stratified based on whether they reported prior urethritis. RESULTS: Of 466 men, 297 reported prior urethritis. Symptomatic men diagnosed with urethritis who reported prior urethritis did not recognize their symptoms as a possible STD earlier than those reporting no urethritis history; there was also no difference between the groups in their interval to presenting for care once symptoms were recognized as a possible STD. Furthermore, men with prior urethritis were as likely to engage in sex acts once they recognized their symptoms as a possible STD manifestation. CONCLUSION: Compared with men without prior urethritis, men with urethritis symptoms who reported prior urethritis did not recognize symptoms earlier, alter health-seeking behavior, or curtail sexual activity.

Comparison of STD burden and risk among men with and without regular doctors attending a southern urban STD clinic.

BACKGROUND: Studies addressing health-seeking behaviors among men at risk for STD are few; this study examines how having a regular doctor might influence risk-taking or STD prevalence. GOAL: The goal was to examine demographic, sexual, and health-seeking characteristics of male STD clinic attendees. STUDY DESIGN: Randomly selected men attending an STD clinic answered a questionnaire regarding the aforementioned characteristics. The men were stratified according to whether they reported having a regular doctor. RESULTS: Of 467 men, 32% reported a regular doctor. These men were more likely to be older, to be better educated, and to state they would seek care for a medical problem at a doctor's office. The two groups did not differ in STD history or prostitute exposure; men without doctors were more likely to have urethritis and STD, although the men with doctors had substantial STD rates. CONCLUSION: Public health clinics remain an important safety net for the management of STD, even for men who report a regular doctor.