The diagnostic challenge of infective endocarditis: cutaneous vasculitis leading to the diagnosis of infective endocarditis.
BACKGROUND
Signs and symptoms of infectious endocarditis are protean. They result from destruction of cardiac endothelium, metastatic embolization, hematogenous seeding, and immune complex deposition. Embolic manifestations of infectious endocarditis can mimic several other pathologic conditions and make the diagnosis of infectious endocarditis difficult.


METHODS
We describe a case of cutaneous vasculitis leading to the diagnosis of infectious endocarditis. A review of the literature highlights the variable clinical presentations and key diagnostic strategies in the evaluation of infectious endocarditis.


CONCLUSIONS
Infective endocarditis has protean clinical symptoms and signs and can be a challenging diagnosis. Being alert to the condition is crucial, and where a high clinical probability exists despite a negative transthoracic echocardiogram, diagnostic evaluation with transesophageal echocardiograph is required.
Conti
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Department of Family Medicine, University of Maryland, Baltimore 21201, USA.
Barnet
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D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004697:Endocarditis, Bacterial / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D016106:Methicillin Resistance; D008875:Middle Aged; D010808:Physical Examination; D013203:Staphylococcal Infections / Q000175:diagnosis*; D013211:Staphylococcus aureus / Q000302:isolation & purification; D014481:United States; D014640:Vancomycin / Q000008:administration & dosage / Q000627:therapeutic use; D014657:Vasculitis / Q000150:complications*
D000900:Anti-Bacterial Agents; D005839:Gentamicins; D014640:Vancomycin