1. Baddour LM, Wilson WR, Bayer AS, et al. Infective endocar-
with identical susceptibility patterns, were found
ditis: diagnosis, antimicrobial therapy, and management of com- on mitral valve, aortic valve, and intraaortic veg-
plications: a statement for healthcare professionals from the Com-
mittee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, etation. These facts make the probability of con-
Council on Cardiovascular Disease in the Young, and the Coun- tamination negligible. Although there is a small
cils on Clinical Cardiology, Stroke, and Cardiovascular Surgery but residual degree of uncertainty regarding dif-
and Anesthesia, American Heart Association: endorsed by the
Infectious Diseases Society of America. Circulation 2005;111(23): ferentiation between an infected intraaortic throm-
e394-e434. [Errata, Circulation 2005;112:2373, 2007;115:e408.]
bus and a primary vegetation, the presence of
2 cm3 of infected material seems clinically rele-
The Authors Reply: Greig and O’Sullivan ques- vant. We believe that it is important for the prac-
tion the infectious nature of the intraaortic vege- ticing clinician to consider unusual presentations
tation and apparently the diagnosis of endocardi- of life-threatening diseases, even if they are not
Since the patient had fever, valve destruction, Oliver Adam, M.D.
valve vegetations, and microbiologic proof of the University Hospital Homburg
presence of pathogens, the standard criteria for 66421 Homburg, Germany
infectious endocarditis were fulfilled. On initial Hermann Hubert Klein, M.D., Ph.D.
transesophageal echocardiography, the aorta was Municipal Hospital
normal, and 6 weeks later, the intraaortic vegeta- 55743 Idar-Oberstein, Germany
tion was visible. Microscopical examination of the Hans-Joachim Schäfers, M.D., Ph.D.
intraaortic mass showed neutrophils and gram- University Hospital Homburg
positive staphylococci. Two types of staphylococci, 66421 Homburg, Germany
Acute Wiiitis To the Editor: A healthy 29-year-old medical der pain was Nintendinitis. However, the variant
resident awoke one Sunday morning with intense in this patient can be labeled more specifically as
pain in the right shoulder. He did not recall any “Wiiitis.” The treatment consisted of ibuprofen for
recent injuries or trauma and had not participat- 1 week, as well as complete abstinence from play-
ed in any sports or physical exercise recently. He ing Wii video games. The patient recovered fully.
consulted a rheumatology colleague. The Patte’s Nintendinitis was first described in 1990,1 and
test was positive, consistent with acute tendonitis there have been many case reports of injuries re-
isolated to the right infraspinatus.
lated to intensive use of recreational technologies,
After further review of his activities during the mainly in children and mainly from intensive use
previous 24 hours, the patient recalled that he had of the extensor tendon of the thumb.2-5
bought a new Nintendo Wii (pronounced “wee”)
With the growing use of this new video-game
video-game system and had spent several hours system, the risk of the Wiiitis variant may be
playing the tennis video game. With the Wii sys- higher than that of Nintendinitis reported in the
tem, the player faces a video screen and moves a literature, especially among adults. The available
handheld controller (approximately 14.5 cm by 3.0 games for the Wii system already include golf,
cm by 3.0 cm, with a weight of approximately boxing, baseball, and bowling. Future games
200 g) containing solid-state accelerometers and could involve different and unexpected groups of
gyroscopes that sense three-dimensional spatial muscles. Physicians should be aware that there
movements. In the tennis video game, the player may be multiple, possibly puzzling presentations
makes the same arm movements as in a real game of Wiiitis.
of tennis. If a player gets too engrossed, he may Julio Bonis, M.D.
“play tennis” on the video screen for many hours.
Unlike in the real sport, physical strength and Instituto Municipal de Investigación Médica
The final diagnosis for the isolated right shoul-
n engl j med 356;23 www.nejm.org june 7, 2007
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1. Brasington R. Nintendinitis. N Engl J Med 1990;322:1473-4. 4. Menz RJ. “Texting” tendinitis. Med J Aust 2005;182:308. 2. Macgregor DM. Nintendonitis? A case report of repetitive 5. Karim SA. Playstation thumb — a new epidemic in children.
strain injury in a child as a result of playing computer games. S Afr Med J 2005;95:412. Correspondence Copyright 2007 Massachusetts Medical Society.3. Koh TH. Ulcerative “nintendinitis”: a new kind of repetitive
strain injury. Med J Aust 2000;173:671. instructions for letters to the editor
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n engl j med 356;23 www.nejm.org june 7, 2007
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Hallam Stevens Date of birth: 30thJuly, 1979 Email: Cell phone: +65 9674-4600 Office Phone: +65 6790-5691 Citizenship: Australia, Great Britain. Publications: Books: Life out of sequence: bioinformatics from the ARPANET to post-genomics. [Under contract, University of Chicago Press] Biotechnology and society [Under contract, University of Chicago Press] Postgenomics (wor