{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T16:40:04Z","timestamp":1756312804422,"version":"3.44.0"},"reference-count":12,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,1,9]]},"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:p>It is recognised that infective endocarditis is frequently a challenging diagnosis to make, as it may present with a range of non-specific symptoms. A middle-aged man was admitted with an 8-day history of profuse non-bloody diarrhoea and vomiting. He had no medical history and no identifiable risk factors for infective endocarditis, and so this in combination with the patient\u2019s atypical symptoms presented a diagnostic challenge. The patient was eventually diagnosed with a <jats:italic>Staphylococcus aureus<\/jats:italic> right-sided infective endocarditis. This case report explores the events which led to this diagnosis and demonstrates a number of unique learning points. It also highlights the importance of maintaining an open mind and being prepared to revise an initial diagnosis in the face of medical uncertainty.<\/jats:p>","DOI":"10.1136\/bcr-2020-239994","type":"journal-article","created":{"date-parts":[[2021,1,25]],"date-time":"2021-01-25T11:46:32Z","timestamp":1611575192000},"page":"e239994","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Diagnostic challenge: an atypical presentation of infective endocarditis"],"prefix":"10.1136","volume":"14","author":[{"given":"Cristina Sarah","family":"Parente","sequence":"first","affiliation":[{"name":"Cardiology, United Lincolnshire Hospitals NHS Trust, Lincoln, Lincolnshire, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura Emma","family":"Sandland-Taylor","sequence":"additional","affiliation":[{"name":"Cardiology, United Lincolnshire Hospitals NHS Trust, Lincoln, Lincolnshire, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Waheed","family":"Akhtar","sequence":"additional","affiliation":[{"name":"Lincolnshire Heart Centre, United Lincolnshire Hospitals NHS Trust, Lincoln, Lincolnshire, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,1,25]]},"reference":[{"key":"2025082709230823000_14.1.e239994.1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.333.7563.334"},{"key":"2025082709230823000_14.1.e239994.2","unstructured":"European Society of Cardiology . ESC guidelines for the management of infective endocarditis. European Society of Cardiology, 2015."},{"key":"2025082709230823000_14.1.e239994.3","unstructured":"British Society for Antimicrobial Chemotherapy . Guidelines for the diagnosis and antibiotic treatment of endocarditis in adults. British Society for Antimicrobial Chemotherapy, 2012."},{"key":"2025082709230823000_14.1.e239994.4","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/94.10.521"},{"key":"2025082709230823000_14.1.e239994.5","unstructured":"Alexiou A , Rau C . Sepsis in adults. BMJ best practice, 2020. Available: https:\/\/bestpractice.bmj.com\/topics\/en-gb\/3000098 [Accessed 24 Dec 20]."},{"key":"2025082709230823000_14.1.e239994.6","doi-asserted-by":"crossref","first-page":"S246","DOI":"10.1086\/598187","article-title":"Patients at risk of complications of Staphylococcus aureus bloodstream infection","volume":"48 Suppl 4","author":"del Rio","year":"2009","journal-title":"Clin Infect Dis"},{"key":"2025082709230823000_14.1.e239994.7","doi-asserted-by":"crossref","first-page":"982","DOI":"10.1016\/j.mayocp.2019.12.008","article-title":"Infective endocarditis: a contemporary review","volume":"95","author":"Hubers","year":"2020","journal-title":"Mayo Clin Proc"},{"key":"2025082709230823000_14.1.e239994.8","doi-asserted-by":"publisher","DOI":"10.1086\/313664"},{"key":"2025082709230823000_14.1.e239994.9","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1093\/ejechocard\/jeq004","article-title":"Recommendations for the practice of echocardiography in infective endocarditis","volume":"11","author":"Habib","year":"2010","journal-title":"Eur J Echocardiogr"},{"key":"2025082709230823000_14.1.e239994.10","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-018-3011-2"},{"key":"2025082709230823000_14.1.e239994.11","doi-asserted-by":"crossref","first-page":"1068","DOI":"10.1016\/j.ekir.2020.04.008","article-title":"Time to acute kidney injury in \u03b2-Lactam-Induced acute interstitial nephritis","volume":"5","author":"Lazarus","year":"2020","journal-title":"Kidney Int Rep"},{"key":"2025082709230823000_14.1.e239994.12","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1007\/s00467-016-3394-5","article-title":"Tubulointerstitial nephritis: diagnosis, treatment, and monitoring","volume":"32","author":"Joyce","year":"2017","journal-title":"Pediatr Nephrol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2020-239994","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T16:23:16Z","timestamp":1756311796000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2020-239994"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1]]},"references-count":12,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,1,25]]},"published-print":{"date-parts":[[2021,1]]}},"alternative-id":["10.1136\/bcr-2020-239994"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2020-239994","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2021,1]]}}}