2019 Volume 83 Issue 4 Pages 841-
A 70-year-old woman presented with a 9-day history of fever and appetite loss (both of which were of unknown etiology), unresponsive to antibiotics and fluids. The patient had a history of diabetes and hypertension, and had undergone ureteral stenting for obstructive pyelonephritis 2 months earlier. The patient was alert but lethargic; her temperature was 38.6℃ and her pulse was 101 beats/min. On physical examination, peripheral signs were noted, including petechiae, Osler’s nodes, splinter hemorrhages, and Janeway lesions (Figure), suggestive of infective endocarditis,1 although no murmur was heard on cardiac auscultation. Echocardiography indicated an abnormal, isoechoic mass around the mitral valve and annular calcification without mitral regurgitation/stenosis or any evidence of abscess (Movie S1). Blood culture was positive for methicillin-resistant Staphylococcus aureus, leading to a final diagnosis of infective endocarditis. Peripheral signs are useful in the diagnosis of infective endocarditis,1,2 especially when cardiac murmur is absent. The patient was treated non-surgically because of multiple small hemorrhagic lesions in the brain, but died 6 days later due to multiorgan failure, probably provoked by distal embolization and progressive disseminated intravascular coagulation.
(A,B) Petechiae in the (A) palpebral conjunctivae and (B) oral cavity mucosa (arrows), (C) slightly raised, painful lesions or Osler’s nodes on the left palm, (D,E) splinter hemorrhages on the nail bed of the (D) left thumb and (E) right fourth digit, and (F,G) non-tender, small, hemorrhagic macules or Janeway lesions on the (F) right first toe and (G) second toe.
None.
The authors declare no conflicts of interest.
Supplementary File 1
Movie S1. Echocardiography.
Please find supplementary file(s);
http://dx.doi.org/10.1253/circj.CJ-18-0854
