Classic Peripheral Signs of Subacute Bacterial Endocarditis

Abstract

A 50-year-old female patient with visual disturbances was referred for further evaluation of a heart murmur. Fundoscopy revealed a Roth spot in both eyes. A physical examination showed peripheral signs of infective endocarditis, including Osler nodes, Janeway lesions, and splinter hemorrhages. Our preoperative diagnosis was subacute bacterial endocarditis with severe aortic regurgitation. The patient underwent aortic valve replacement and was treated with intravenous antibiotics for 6 weeks postoperatively. The patient made a remarkable recovery and was discharged without complications. We report this case of subacute endocarditis with all 4 classic peripheral signs in a patient who presented with visual disturbance.

A Case Report of Subacute Infective Endocarditis Presenting With Extreme Weight Loss, Aortic Regurgitation, and Splenic Infarct

“…Weight loss was the chief complaint that brought the patient into the hospital. Although weight loss is not generally associated with acute IE, it correlates with subacute endocarditis [7]. The patient described a 40lb weight loss over a short period; this is considered a red flag in modern medicine, and as such, a proper workup should have been initiated to find the underlying cause.…”

Dermatological Changes in Patient With Infective Endocarditis

“…Osler nodes, Janeway lesions, and Roth spots are all known as classic diagnostic signs of IE, although these manifestations occur in a small percentage of cases (Wang et al, 2018). Osler nodes are described as tender nodules found on the finger and toe pads that are erythematous with a pale center (Chong et al, 2016;Parashar & Daveluy, 2020). Janeway lesions are nontender, erythematous macules or papules found on the palms and soles (Parashar & Daveluy, 2020).…”

Lactobacillus acidophilus Endocarditis Complicated by Pauci-Immune Necrotizing Glomerulonephritis

“…Lactobacillus bacteremia and an aortic valve vegetation seen on echocardiogram established the diagnosis of IE. The typical signs and symptoms of IE, fever, heart murmur, Janeway lesions, splinter hemorrhage, and Osler nodes [ 5 ], were initially not present. Although uncommon, acute cerebrovascular accidents as initial presentation of aortic valve endocarditis have been reported previously [ 6 ].…”