ABSTRACT
A 79-year-old woman with a background history of hypertension, diabetes mellitus, hypercholesterolemia, alcoholic liver disease, and osteoporosis presented to the hospital with fever and confusion. Based on the initial investigations, it was challenging to identify the primary source of infection. Positive group G streptococcus on blood cultures raised the suspicion of uncommon infective endocarditis (IE). Two transthoracic echocardiographic studies were performed a week apart, and both were inconclusive. She was also diagnosed with atrial fibrillation, and the decision for anticoagulation became difficult as the clinical suspicion for IE was very high. Fluorine-18-fluorodeoxyglucose (18F-FDG) PET/CT confirmed the diagnosis of native valve endocarditis (NVE), and the possible complication related to anticoagulation was prevented. Though 18F-FDG PET/CT is commonly used to evaluate prosthetic valve endocarditis (PVE) and IE related to cardiac devices and catheters, its role and applicability to evaluate challenging cases of NVE could be entertained.
ABSTRACT
A 36-year-old lady presented with fever, cough, maculopapular rash, painless sialadenitis, episcleritis, and arthralgia of more than 10 months, occurring in episodes since she tested positive for COVID-19 in 2020. Her symptoms were well controlled with corticosteroid and immunosuppressant therapy. Her clinical presentation and findings on bronchoscopy resembled that of sarcoidosis. However, the bronchial biopsy histopathology ruled out sarcoidosis. An increased serum immunoglobulin G4 level and its possible association with COVID-19 raises the question of whether the possibility of immunoglobulin G4-related disease (IgG4-RD) could be entertained.
