Bárbara Baptista’s research while affiliated with Hospital da Figueira da Foz and other places

Infective endocarditis (IE) is a rare and potentially fatal infection of the heart valves, often caused by streptococci, staphylococci, and enterococci. This case is particularly significant as it describes IE caused by Streptococcus viridans in a 36-year-old male patient, previously healthy with no known risk factors, who presented with a three-week history of fever, night sweats, and fatigue. Initially, the clinical presentation was attributed to an atypical infection due to his occupational exposure, and he was empirically treated with doxycycline, showing apparent clinical improvement. However, blood cultures were positive for Streptococcus viridans, leading to hospitalization and suspicion of endocarditis. Echocardiography revealed congenital aortic valvulopathy (bicuspid aortic valve) with moderate regurgitation but no evidence of vegetation. A transesophageal echocardiogram identified vegetations, confirming the diagnosis of IE. Treatment with ceftriaxone and gentamicin resulted in a favorable clinical response after four weeks. This case highlights the diagnostic challenges of IE in atypical presentations and the importance of considering IE in patients with fever and positive blood cultures, even in the absence of known cardiac disease or previous risk factors. It also emphasizes the need for timely diagnosis to prevent severe complications associated with endocarditis. The authors aim to underscore the indolent course of IE in this rare clinical presentation.

A síndrome de Löfgren é uma forma de apresentação aguda da sarcoidose que ocorre em até metade dos indivíduos com esta doença. O seu diagnóstico é mais frequente em mulheres caucasianas até aos 35 anos. Caracteriza-se pela tríade: eritema nodoso, linfadenopatias hilares bilaterais e poliartralgias.A sarcoidose nodular trata-se de uma variante rara da sarcoidose cujo padrão, por mimetizar outras patologias, atrasa o diagnóstico de sarcoidose.Descrevemos o caso de uma mulher caucasiana, de 30 anos, que recorreu ao Serviço de Urgência por edema dos membros inferiores e artralgias com seis dias de evolução. Analiticamente, apresentava elevação dos parâmetros inflamatórios, da velocidade de sedimentação e anemia. Radiografia torácica com alargamento dos hilos. A tomografia computorizada do tórax mostrou vários nódulos mediastínicos, hilares e pulmonares.Apresentamos a marcha diagnóstica de uma variante rara de sarcoidose com uma apresentação clínica típica.