iatroX Rounds #8
The clues
- 1
A 52-year-old man presents with a six-week history of worsening malaise, night sweats and unintentional weight loss.
- 2
He notes that his symptoms began shortly after he underwent a dental procedure for a periapical abscess two months ago.
- 3
His past medical history is significant for a mitral valve replacement and a period of intravenous drug use in his twenties.
- 4
Physical examination reveals a temperature of 38.1 degrees Celsius, a new pansystolic murmur and small, painless, red spots on the palms of his hands.
- 5
Bedside urinalysis is positive for blood, and blood tests show a normocytic anaemia with a significantly raised C-reactive protein.
- 6
Transthoracic echocardiography demonstrates a large, mobile, oscillating mass on the prosthetic valve with significant regurgitation.
Infective endocarditis is a microbial infection of the heart valves or endocardium, often occurring in patients with pre-existing structural heart disease or prosthetic valves. It typically presents with a combination of constitutional symptoms, valvular dysfunction, and immunological or embolic phenomena.
- Persistent fever and constitutional symptoms
- New or changing heart murmur
- Janeway lesions and Osler nodes
- Microscopic haematuria and splinter haemorrhages
more Cardiology rounds
for education and entertainment. not medical advice.