A 22-year-old female presented to our hospital with undiagnosed medical condition. Her signs and symptoms included chest pain, general fatigue, persistent coughing, dizziness, photosensitivity and weakness. Her previous medical history included laboratory investigations for hypothyroidism, Addison’s disease, autoimmune diseases, tuberculosis, and other granulomatous pathoses. All were negative. The lab results read normal to within normal. Consulting an otolaryngologist, his report diagnosed no more than mild otitis media and sinusitis. Referring this patient to a dentist, he reported a variable periodontal affection: from mild to severe local periodontitis, geographic tongue, chronic osteomyelitis at an extraction site, sialadenitis and recurrent mucosal ulceration. Sonographic assessment of the head and neck as well as salivary and blood culture were requested. Running these tests, the microbiological report was highly suggestive of HACEK infection of which haemophilus and aggregatibacter species were the most frequent. The sonographic study revealed normal structures, save for non-specific cervical lymphadenopathy.
The patient was referred to a cardiologist to manage the condition. After reassessing her condition by the transthoracic echocardiogram, dilated left ventricle and rheumatic affectation of the mitral valve with regurgitation were concluded. There was no evidence of any vegetation. The patient started a therapeutic course of long-acting penicillin.