TY - JOUR T1 - A Rare Presentation of Endocarditis in Adult-onset Still’s Disease in Diagnosis of Fever of Unknown Origin JF - The Journal of Rheumatology JO - J Rheumatol SP - 198 LP - 199 DO - 10.3899/jrheum.110935 VL - 39 IS - 1 AU - BULENT M. ERTUGRUL AU - GULIZ UYAR AU - BARCIN OZTURK AU - SERHAN SAKARYA Y1 - 2012/01/01 UR - http://www.jrheum.org/content/39/1/198.abstract N2 - To the Editor:Adult-onset Still’s disease (AOSD) was first described by Bywaters in 1971, with descriptions of 14 patients1. Differentiation between microbial infections and rheumatic diseases such as AOSD remains difficult in many cases. Heart involvement in AOSD is uncommon and valvular involvement is extremely rare. We describe a case of AOSD in a 39-year-old woman who presented with fever, endocarditis, and hyperferritinemia.Our patient was admitted to the emergency service with fever and chest pain. One week before she had had a sore throat, so she was given amoxicillin-clavulanate 2 × 1000 mg/day for 1 week. On examination, tachycardia and apical 2/6 systolic murmur were detected. Cardiac enzymes were normal. Laboratory tests (Table 1) showed acute-phase inflammation and leukocytosis. Cardiomegaly was seen on chest radiography. Echocardiography (ECO) showed mitral stenosis, 1.7 cm pericardial effusion, second-degree mitral insufficiency, and second- and third-degree aortic insufficiency. She had a fever of 38.7°C, and blood cultures were obtained. In transesophageal ECO, 0.6 × 0.5-cm diameter vegetation on aortic valve was seen. The diagnosis was … Address correspondence to Dr. B.M. Ertugrul, Department of Infectious Diseases and Clinical Microbiology, University of Adnan Menderes, School of Medicine, 09100 Aydin, Turkey. E-mail: bertugrul{at}adu.edu.tr ER -