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Subacute and acute infective endocarditis
Clinical Picture
Subacute and acute infective endocarditis Robert A Fowler, Samir Gupta Lancet 2005; 366: 1964 Department of Medicine and Department of Critical Care Medicine, Sunnybrook and Women’s College Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Room D478, Toronto, Ontario M4N 3M5, Canada (R A Fowler FRCP[C], S Gupta MDCM) Correspondence to: Dr Robert A Fowler [email protected]
1964
A 72-year-old man with a 3-month history of fatigue and weight loss of 9 kg presented to hospital with a diffuse lower extremity rash. On examination, we found conjunctival petechiae, non-tender violaceous lesions on his palms and fingers, palpable purpura and petechiae over his legs and buttocks (figure, A), and a pansystolic murmur (grade III/VI) at the left lower sternal border, which radiated to the axilla. He had a normocytic anaemia and mild renal failure. While receiving a transfusion of red blood cells, he developed acute pulmonary oedema (figure, B) and was endotracheally intubated. We did a transthoracic echocardiography, which revealed a mobile mass on the posterior mitral valve leaflet and severe regurgitation. We treated the patient with intra-aortic balloon counter-pulsation and mitral valve replacement. Blood cultures subsequently grew Streptococcus oralis. He completed 6 weeks of antibiotic therapy and apart from residual renal insufficiency is recovering well.
www.thelancet.com Vol 366 December 3, 2005
Subacute and acute infective endocarditis Robert A Fowler, Samir Gupta Lancet 2005; 366: 1964 Department of Medicine and Department of Critical Care Medicine, Sunnybrook and Women’s College Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Room D478, Toronto, Ontario M4N 3M5, Canada (R A Fowler FRCP[C], S Gupta MDCM) Correspondence to: Dr Robert A Fowler [email protected]
1964
A 72-year-old man with a 3-month history of fatigue and weight loss of 9 kg presented to hospital with a diffuse lower extremity rash. On examination, we found conjunctival petechiae, non-tender violaceous lesions on his palms and fingers, palpable purpura and petechiae over his legs and buttocks (figure, A), and a pansystolic murmur (grade III/VI) at the left lower sternal border, which radiated to the axilla. He had a normocytic anaemia and mild renal failure. While receiving a transfusion of red blood cells, he developed acute pulmonary oedema (figure, B) and was endotracheally intubated. We did a transthoracic echocardiography, which revealed a mobile mass on the posterior mitral valve leaflet and severe regurgitation. We treated the patient with intra-aortic balloon counter-pulsation and mitral valve replacement. Blood cultures subsequently grew Streptococcus oralis. He completed 6 weeks of antibiotic therapy and apart from residual renal insufficiency is recovering well.
www.thelancet.com Vol 366 December 3, 2005