Haemorrhagic knee- just the tip of an iceberg

Fever associated with painful joint and effusion points most of the time towards septic arthritis, probably of bacterial etiology which can also be the first manifestation of infective endocarditis. Septic arthritis is not an uncommon presentation in infective endocarditis. We had an experience with a rare presentation of infective endocarditis where a 15 years old girl came with painful joint effusion. She was evaluated and blood investigations showed elevated ASO titre and total leukocyte count. Transoesophageal echocardiogram revealed infective endocarditis. Having known the rare presentations of infective endocarditis a thorough evaluation of patient should be done in order to not miss the bigger diagnosis such as infective endocarditis.