{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T10:20:29Z","timestamp":1781173229567,"version":"3.54.1"},"reference-count":13,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2024,8,1]],"date-time":"2024-08-01T00:00:00Z","timestamp":1722470400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,8,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Iron deficiency is the leading cause of anaemia worldwide and frequently observed in adolescent women, particularly those with eating disorders like anorexia nervosa. Consequently, clinicians may overlook iron deficiency anaemia, potentially missing a more serious diagnosis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>A 19-year-old woman was referred to the hospital by her general practitioner due to worsening symptomatic iron deficiency anaemia, despite treatment with oral iron supplementation. Her blood cultures consistently grew Streptococcus sanguinis, and an echocardiogram revealed vegetations on the mitral and tricuspid valves, confirming the diagnosis of infective endocarditis. Several systemic complications of varying acuity were identified, including a ruptured left common iliac artery aneurysm with active haemorrhage into the left psoas muscle, enlarging cerebral, hepatic, and right common femoral artery aneurysms, splenic infarction with abscess formation, and an infected left psoas muscle haematoma. Multimodal imaging and collaboration within the multidisciplinary endocarditis team were crucial for coordinating further evaluation and managing the complex array of peripheral lesions in infective endocarditis. The patient was discharged with a good clinical outcome after 81 days.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>This case highlights the risks of overlooking iron deficiency anaemia in adolescent women with anorexia nervosa and the serious consequences of untreated complicated infective endocarditis. It emphasizes the need for thorough investigation of anorexia nervosa patients for infections due to their reduced clinical response, to ensure early diagnosis and treatment.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytae388","type":"journal-article","created":{"date-parts":[[2024,7,31]],"date-time":"2024-07-31T22:12:49Z","timestamp":1722463969000},"source":"Crossref","is-referenced-by-count":3,"title":["Unveiling the devastations of <i>Streptococcus sanguinis<\/i> infective endocarditis masquerading as iron deficiency anaemia: a case report"],"prefix":"10.1093","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7653-8825","authenticated-orcid":false,"given":"Bing Wei Thaddeus","family":"Soh","sequence":"first","affiliation":[{"name":"Department of Cardiology, University Hospital Waterford , Dunmore Rd, Ballynakill, Waterford X91 ER8E , Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-0602-9822","authenticated-orcid":false,"given":"Arifa","family":"Salim","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, University Hospital Waterford , Dunmore Rd, Ballynakill, Waterford X91 ER8E , Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth","family":"O'Riordan","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, University Hospital Waterford , Dunmore Rd, Ballynakill, Waterford X91 ER8E , Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4951-171X","authenticated-orcid":false,"given":"Patrick","family":"Owens","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Hospital Waterford , Dunmore Rd, Ballynakill, Waterford X91 ER8E , Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5590-5665","authenticated-orcid":false,"given":"Sajjad","family":"Matiullah","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Hospital Waterford , Dunmore Rd, Ballynakill, Waterford X91 ER8E , Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,8,1]]},"reference":[{"key":"2024081915462498400_ytae388-B1","doi-asserted-by":"crossref","first-page":"e713","DOI":"10.1016\/S2352-3026(23)00160-6","article-title":"Prevalence, years lived with disability, and trends in anaemia burden by severity and cause, 1990\u20132021: findings from the Global Burden of Disease Study 2021","volume":"10","author":"Collaborators","year":"2023","journal-title":"Lancet Haematol"},{"key":"2024081915462498400_ytae388-B2","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1111\/j.1651-2227.2007.00172.x","article-title":"Haematological changes and iron status in teenage girls with eating disorders and weight loss\u2014the importance of menstrual status","volume":"96","author":"Swenne","year":"2007","journal-title":"Acta P\u00e6diatrica"},{"key":"2024081915462498400_ytae388-B3","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1111\/j.1601-5215.2008.00286.x","article-title":"Immunological disturbance and infectious disease in anorexia nervosa: a review","volume":"20","author":"Brown","year":"2008","journal-title":"Acta Neuropsychiatr"},{"key":"2024081915462498400_ytae388-B4","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1002\/eat.20135","article-title":"Bacterial infections in anorexia nervosa: delayed recognition increases complications","volume":"37","author":"Brown","year":"2005","journal-title":"Int J Eat Disord"},{"key":"2024081915462498400_ytae388-B5","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1001\/archinternmed.2008.603","article-title":"Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis\u2013Prospective Cohort Study","volume":"169","author":"Murdoch","year":"2009","journal-title":"Arch Intern Med"},{"key":"2024081915462498400_ytae388-B6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/omi.12192","article-title":"How to become a killer, or is it all accidental? 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