Personality Disorder as the Initial Presentation of a Complicated Endocarditis: Diagnostic Challenges in the CARDIO-PSYCHIATRY

M. Zúñiga, A. Perez-Cuadra, Jorge Villalpando-Hernández, R. Díaz-Pérez, Ricardo A. Valdovinos-Nuñez

Cardiovascular Disorder and Medicine, 2020

Abstract

Background: Bacterial endocarditis is a rare infectious entity with a very heterogeneous clinical spectrum;

neurological manifestations are the most frequent and serious extracardiac complications of infective

endocarditis. However, little is known about the psychiatric manifestations and / or sequels due to septic

embolism of the infective endocarditis.

Case Report: 50-year-old male, history of arterial hypertension and nephrolithiasis with recurrent urinary

tract infections. He began his condition with behavioral changes characterized by marked impulsivity and

instability in his interpersonal relationships, adding repetitive events of fever and nephrolithiasis requiring

urological interventions and antibiotic therapy. Upon admission assessed by psychiatry because of his

impulsive behavior and emotional changes with the presumptive diagnosis of borderline personality

disorder.

Conclusion: In the following work we describe the first case found in the literature of a psychiatric

manifestation in a male patient as the initial complication of a subacute bacterial endocarditis, his diagnostic

approach, clinical picture and therapeutic outcome. The early recognition of the clinical picture and the

diagnostic approach allowed to establish effective antibiotic treatment; to recognize that bacterial

endocarditis might present in a multifaceted way allows to suspect this disease and give treatment

opportunely to reduce its burden and mortality.

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