A sneaky case of endocarditis

The clinical history of infective endocarditis is highly variable depending on the pathogen detected, the presence/absence of pre-existing cardiac disease and way of presentation. Therefore infective endocarditis suspicion should be placed in different clinical situations. Infective endocarditis may have an acute and rapidly progressive course, but it can also occur in subacute or chronic low-grade fever and nonspecific symptoms, making difficult the initial clinical evaluation. In the elderly or immunocompromised patients infective endocarditis often has an atypical onset, less frequently accompanied by a fever than is seen in younger subjects. In this category of patients the disease should be suspected and implement appropriate investigations to rule out the presence of infective endocarditis.