Abstract
A 29-year-old female had fever and headache since October 2003, and transient and tender purpura with regional edema also had been noted repeatedly since November 2003. She was examined for fever of unknown origin and anemia in the Internal Medicine Department at our hospital. On 5 December 2003, the patient was referred to us for further investigation of the eruption. Laboratory data were noncontributory except for inflammatory findings with neutrophilia. Since painful purpura was observed on the left ventral toes at presentation, we performed skin biopsy from the purpura to rule out embolism or vasculitis. Histopathological findings included cell infiltration predominantly composed of neutrophils accompanied by nuclear dust throughout the dermis and in subcutaneous tissue. Histology also revealed an embolus in a relatively large vessel. Echocardiogram 3 weeks later showed vegetation on the mitral valve. Blood cultures grew Streptococcus mitis. Based on these findings, we diagnosed this patient as having infective endocarditis. Dermatologists must be familiar with various eruptions associated with infective endocarditis, because such cutaneous manifestations are very useful in diagnosing the disease as described in this report.
