Infective Endocarditis with Peripheral Embolization (Case Study)

Author : Jefri, E. Phangestu, V. H. Wahidji
Upload Date : 19-04-2018

Introduction: Infective endocarditis (IE) is a rare disease which accounts 5 per 100.000 cases per year. An acute infective endocarditis is still a medical burden with high mortality rate. The physical signs of endocarditis are numerous and include heart murmurs and peripheral signs of endocarditis which are much less common. The present of classical signs can help us to identify the event of peripheral embolization in IE.

Case Report: This case study describes a 14 years old male child who came to our Emergency Department with fever for about 9 days. On the fifth day of fever rashes appeared on palms. Prior history of sore throat with multiple arthralgia several years ago. No history of congenital heart disease. BP: 100/70, HR: 122x/minute, temperature: 38,9o celcius, a holosystolic murmur at apex, no crackles on both lungs. On palms we found classical splinter hemorrhage, janeway lesion, and Osler’s node. Lab examination: leukocytosis (22.100/ml) with neutrophilia. Patient then undergoing TTE with result: LA enlargement, moderate MR, and vegetation about 1,5 – 2 cm on posterior of AML. The patient was diagnosed with definite infective endocarditis as they met 1 major and 3 minors of modified Duke criteria then received high dose adjustment of empirical antibiotics.

Discussion: Embolic events are a frequent and life-threatening complication of IE related to the migration of cardiac vegetations. The risk of embolic events in IE consistently related to vegetations more than 10 mm in length. About 10% patient with IE present a classical peripheral embolization sign, such as splinter hemorrhage and janeway lesion.

Conclusion: The peripheral manifestations of endocarditis are venerable signs that may be useful adjuncts to the diagnosis of endocarditis. Although rare, IE has to be suspected in any patient presenting with fever and embolic phenomena.

KEYWORDS : Infective endocarditis, Janeway lesion, Splinter hemorrhage

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