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Endocarditis with Confusion and Hand Pain

An 83 year old Hispanic female was admitted with right hand pain for one week and confusion, chills, and lethargy for one month. Medical history included prior strokes and bioprosthetic mitral valve (MV) and aortic valve (AV). Exam was notable for fever to 100.5° F, a new 2/6 systolic murmur, bilateral pulmonary crackles, exquisite tenderness and purple discoloration of the fingertips of the right hand (figure 1), and subconjunctival hemorrhages (figure 2). Laboratory investigations revealed leukocytosis to 14,000 and microscopic hematuria on urinalysis. Transesophageal echo (TEE) showed 8 x 5.4 mm AV vegetation and 14 x 9.7 mm MV vegetation. The study was unable to exclude presence of an AV annular abscess. Additionally, neurologic evaluation with CT angiogram was negative for new ischemic infarct or mycotic aneurysm. Two sets of admission blood cultures were positive for Streptococcus salivarius sensitive to penicillin (MIC≤0.03).

 Confusion_Image1_Chawla.jpg

Confusion_Image2_Chawla.jpg 

 

 


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Biographies:
Dhruv Chawla is a second year internal medicine resident at Rush University Medical Center in Chicago, IL. He plans to pursue a career in cardiology.

Yoona Rhee is a fellow of infectious disease at Rush University Medical Center in Chicago, IL.

Kamaljit Singh, MD is an assistant professor of infectious disease at Rush University Medical Center in Chicago, IL. Dr. Singh’s areas of clinical expertise include clinical microbiology, travel medicine, and tropical infections.

 


 

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