Infectious Endocarditis with Major Cutaneous Expression: About A Case

Abstract

Introduction: Infectious endocarditis is a transplant of microorganisms in healthy endocardium, in injured endocardium or intracardiac material. The modes of revelation can be multiple and varied, the skin manifestations of an infectious although classical endocarditis, are rare. Observation: This was a young 20-year-old patient, admitted in our cardiac unit for the exploration of a cardiac murmur in a context of long-term fever evolving for nearly 3 weeks associated with a skin rash. The examination found fever at 39°C and tachycardia at 115 beats/min. The cardiac auscultation revealed tachycardia with a systolic breath apexian mitral insufficiency. The skin examination revealed Osler’s nodules, an erythema of Janeway on the soles of the feet and on the palms of the hands. In biology, there was a non-specific biological inflammatory syndrome. Blood cultures from three series of samples did not isolate a germ. The transthoracic echography showed large vegetations in the anterior and posterior leaflets of mitral valve associated with severe mitral regurgitation. In this context, the diagnosis of mitral endocarditis is retained according to the Duke criteria. A double intravenous antibiotic therapy based on ceftriaxone and gentamycin was administrated. The evolution was favorable with stable apyrexia, disappearance of skin signs, regression of non-specific biological inflammatory syndrome. A replacement surgery of mitral valve was proposed. Conclusion: Infectious endocarditis is a disease with multiple and varied modes of revelation. Although skin manifestations are rare, they are still a determining factor in the diagnosis of infectious endocarditis.